Mast: Y.P Age: 2 ½ yrs/Male
Child had come with watery nasal coryza and cough from 4 days with low ↓Appetite & dullness. From 5th day developed high grade fever with chilliness < evening. Had 1 episode of vomiting associated with irritability, carried desire to be & teeth grinding.
Past history 2 episode of Lower Respiratory Tract Infection, 2 episodes of Acute Gastroenteritis.
Physical examination T– 1010 F, P/R – 110/min, R.R. – 23/min Respiratory System – Bilateral Crepts + CVS- S1S2 normal P/A- Soft
Investigation Hb 9.4%, WBC 12,400 N 74, E 2, M 2, L 22 Chest X ray left Lower Lobe Homogenous opacity consolidation+
Diagnosis Pneumonia (Late stage)
Mental generals Active and playful child. Dominating – While playing expects that others should obey his rules, keeps finding mistakes with others. Irritable – on slightest provocation. Egoistic – Does not readily mix with people and judges their suitability before befriending them. Does not like to be scolded and becomes angry. Sharp memory – Good memory of events, names etc.
Physical general Craving – Egg , Garlic , Chana. Hot patient.
In this chronic case structures affected are lungs with Left Lower Lobe consolidation & GIT. Functional changes are ↑ Mucous secretion→coryza, GE; ↑ Cough reflex; ↑ Temparature& PR. Form of presentation of symptoms are as Gradual pace onset, Evening ↑ Temp., Weakness & desire to be carried, Availability certain characteristic mental generals. This all indicates moderate deviation from state of health & ↑robust susceptibility
Totality of symptoms
|S.NO||Chronic Totality||Acute Totality|
|1||Dominating/Egoistic||Irritability heat during|
|2||Irritable||Carried desire to|
|3||Sharp memory||Thirst increased for||sips freq.|
|4||Desire Egg, Garlic, Chana||Fever < evening|
- Lt sided affinity
- Irritable, full of anxiety & fear.
- Fever with more violent Heat.
- Thirst for stimulants.
- < 11am
- Aversion to business due to laziness.
- Sleep- wakes up happily singing in morning.
- Sided affinity.
- Fever with icy coldness as if lying on ice.
- Thirst for Warm drinks.
- < 4-8 pm
- Irritability & aversion to undertake new things
- lack of confidence.
- Sleep- sadness on waking up.
- < warm weather, 4-8pm Chest pain > sitting up.
- < cold weather , 3am
- Chest pain > sitting with leaning forward.
Final Selection: Lycopodium
Of the three remedies Lycopodium covered the acute & chronic totality of the patient. Hence it was the choice of remedy over Sulphur and kali carb.
|First Day||Temp – 1010F, Cough ++||Lycopodium 10m single dose|
|Second Day||Fever > but relapse cough > but relapse||Lycopodium 10m single dose|
|Third Day onwards||No complaints, X ray chest with complete resolutionof lung parenchyma||Placebo|
Patient had two episodes of lower respiratory tract infections before this episode. Hence a drug which suits both acute & chronic symptom was best selected. There were characteristic generals in totality including mental generals in both acute and chronic totality, indicating highly robust susceptibility hence high potency in single dose was used. Lycopodium was used in high potency with the hope of cutting down or aborting the course of disease. Since the susceptibility was robust and correspondence of remedy complete, the physician took the risk of aggressive strategy through creating a crisis as suggested by Borland.
Borland’s advice on role of potencies
- With too low potencies you avoid the complications of the disease, make patients more comfortable and reduce mortality rate. But by this method you do not reduce the duration of disease.
- By the administration of higher potencies, – you will find that you abort the disease. It does not run its normal course; the duration of the illness is very much shortened and you have an anticipated crisis.
- As far as the high potencies are concerned, I think it is wiser to give the drug every 2 hours, the reason being that you want a number of stimuli in a comparatively short period of time in order to obtain the crisis within 12-24 hours.
Debate of Strategies Lysis V/S Crisis.
Answer to the debate lies in assessment of susceptibility and Miasm.
- If the indicators of susceptibility are robust; like characteristics are robust, pathology is just setting in, early stage of disease, general condition is good, no compromise in vitality and essentially psoric response from patient and if the correspondence of indicated remedy is complete, it is safe to aggressively barge in by creating crisis and cut short or abort the course of illness.
- If the indicators of susceptibility are weak; Not much characteristics, well established inflammation or its complication, general debility, vitality compromised, underlying co morbidity essentially, tubercular or syphilitic miasm expressions, it is better to follow slow yet safe method of using low potency. Support the susceptibility to withstand the disease force and allow it to tide over. Choose steady lysis of disease. Patient is comforted by relief in symptoms and prevention of complication while disease runs its full course.
- Homoeopathy has the potential and the capability to counter and diffuse infections based on the principle of individualisation. Homoeopathic approach in pneumonia is no different.
- Totality of symptoms; i.e. the pathognomonic common symptoms of the disease caused due to infection and Characteristic symptoms exhibited by the individual as a reaction to the infection are our guiding post to establish diagnosis and select homoeopathic remedies, respectively.
- Diagnostic knowledge and skills are critical for suspecting, identifying and confirming the diagnosis of pneumonia. Clinico- pathological correlations are essential for understanding inflammatory stages of pneumonia and hence the group of remedies based on stage & type of pneumonia as suggested by Borland.
- Groups suggested by Borland in 1939 based on the tissue affinity, still hold true and are seen by contemporary physicians in practice. Group I (incipient) Aconite, Belladonna, ferumPhos. Group II (Frank) Bryonia, Chelidonuim , Phosphorus, Group III( Bronchopneumonia) Nat Sulph, Puls, lobelia Senega, Group III (Complicated) Lach, Rhus Tox, Merc, HeparSulph , Pyrogen Group IV (Late) Carbo Veg, Ant. Tart, Kali Carb, Lycopodium, Ars Alb, Sulph.
- In homoeopathic prescribing for pneumonia, the endeavour is to find a drug that will cover not only the actual pathological picture but also reaction of the individual patient to the infection. Individual reactions are exhibited through peculiar symptoms like; Causations, Generals, Concomitants, Modalities, and Sensations.
- Case taking should focus on evolutionary picture of the disease on day to day basis. Patiently, each symptom and sign should be elicited and recorded on time line to understand onset duration and progress.
- The trio of pace of disease, stage of pathology and evolution of characteristic symptoms are the basis of susceptibility assessment. Identifying pace and stage of the disease in pneumonic inflammation goes a long way in providing assessment of susceptibility of the patient.
- Miasm plays a significant role in deciding how a pneumonia is going to progress and how an individual will react in the course of the illness. Identifying phases of pneumonia from Posra to Syphilis helps in formulating strategy.
- Strategy of management of pneumonia e.g Crisis or Lysis, use of acute or constitutional remedy, choice of potency and repetition is based on understanding of susceptibility and miasm of a given case.
- Homoeopathic management of pneumonia is an art formulated on scientific principles of Homoeopathy which can be learnt and perfected by practice alone.
- API Text Book Of Medicine 9th Edition (2012 )
- Current Medical Diagnosis and Treatment 2015
- Homoeopathic Leaders in Pneumonia By Dr. A Pulford, Dr.D.T Pulford, B Jain Publishers, Reprint Edition 2004.
- Organon Of Medicine By Samuel Hahnemann, 6thEdition, Reprint Edition 2003, Ibpp Publishers
- Oxford Hand Book Of Clinical Medicine 2014
- Pneumonias By Dr. Douglas M.Borland, B Jain Publishers, Reprint Edition 2003, 2008.
- Robbins Cotran Pathologic Basis Of Disease 9th Edition