Creating Waves of Awareness
(Article published in the November issue of Homoeopathic Heritage)
Dr Muhammed Rafeeque, BHMS, PGNAHI.
On the basis of duration, diseases can be broadly classified in to acute, sub acute and chronic. The literal meaning of the word 'acute' is - something having or experiencing a rapid onset and short but severe course. In the field of medicine also an 'acute disease' means a disease having a rapid onset with intense symptoms and a short duration of complaints. Even though, a good number of acutes are self-limiting and mild in intensity, sometimes, it can be fatal or even precipitate some sequelae. Apart from that, throughout the course of sickness, the affected victim suffers a lot. Hence, acutes should be managed skillfully using drugs that are free from side effects. But, the fact is, a notable percentage of people post serious risk to their health by misusing drugs that can lead to incurable Drug-borne diseases. They keep on using these dangerous drugs that are available over-the-counter, even without consulting a doctor.
Acute diseases in Homeopathy
As per the common usage in the field of medicine, acute lasts for a few days, chronic lasts for several months or years and the sub-acute is a connecting link between the two. On the other hand, in homeopathy, the terms acute and chronic have got different meaning! An acute is acute from its origin to the end; similarly, a chronic is chronic from its origin to the end. That means, an acute disease never continues as a true chronic disease. However, suppression of an acute episode can sensitize the dormant miasms that are responsible for the chronic diseases. When an acute complaint is repeatedly suppressed, it can sensitize the miasm and the disease becomes deeper seated - affecting the vital organs. Some times, acute and chronic diseases can mimic each other. For example: a foreign object lodged in our body can cause some acute clinical manifestations. If that object is not removed either manually or by the body itself, it can continue as a sub-acute and then as chronic troubles, which in turn mimics a chronic disease. But as per homeopathy, it is not a true chronic disease. In common parlance, the acute exacerbations are considered as acute diseases, but they are actually not acute diseases, but a sudden expression of the dormant miasms due to some external stimuli, hence it is a part of chronic disease only.
The acutes are rapid morbid processes as a result of deranged vital force, which is caused or triggered by some abnormal states, life circumstances, sensitivity, reactions, excessive hardships, bodily injuries, altered surroundings, laboring in swamps, errors in diet, poor hygiene, physical agents, atmospheric changes, excess of cold or heat, emotional trauma etc. These are basically due to an explosion of the latent psora as a response to the external stimuli.
Types of acutes
Acutes may be:
· Individual or Solitary
· Epidemic affecting a group of people. Epidemics are due to acute miasms (Recurring and non recurring)
Another way of classification is:
· Artificial acutes: Due to exposure, living in poor hygiene, overwork, injury, drugs etc.
· Natural acute diseases: Epidemic, endemic, sporadic, contagious, and infectious.
There are certain myths related to acute disease and its management.
“Homeopathy can not work for acute diseases”
The truth is, homeopathy can cure acute diseases more rapidly and gently without causing any side effects.
“Homoeopathy is very slow, hence can work only for chronic cases”
A Homeopathic medicine starts working immediately when it is administered to the sick person, whereas other medicines need to be absorbed by the body. The reason for such misconception among the public is, there are many people taking homeopathy for their chronic diseases, which are deep seated, and hence certain time is needed to cure the patient from the grass root level, but this is not applicable while treating an acute disease. Most of the time, the patient himself can experience a mental and physical well being immediately after taking the first dose itself.
“All acute diseases are self limiting, hence placebo is enough”
Self-limiting-disease does not mean that no medicine is needed for its management. The vital force can try to bring back the normalcy from a diseased state, but this is not always possible, hence an external stimuli in the form of medicine is needed. True that some acute diseases are self-limiting, but they can also take the life of the patient unless properly managed. Apart from that, the affected person will have a number of troubles throughout the sickness, hence his sufferings has to be reduced. Moreover, an acute episode can also precipitate some sequelae, hence treatment of an acute episode is very essential.
“Need not prescribe for an acute exacerbation when the patient is already under a constitutional drug, because an acute drug given can affect the action of the chronic drug”
A person already under a chronic drug when suffering from an acute episode will be having a changed picture called the acute totality. Hence it is meaningless to continue the chronic drug. An acute drug, homeopathic to the present totality has to be administered in suitable potency (preferably lower potency) and dose. Once the acute stage is cured, the chronic drug can continue its action.
“Antibiotic is a must to treat acute infections”
The statistical data proves that homeopathy has effectively cured different types of infections that were not responding to strong antiviral agents and antibiotics. But there is a misconception propagated through different media (funded by the drug business lobby) that antibiotic is a must to treat infections. Nowadays we can clearly observe that the panic created by the infectious diseases is more dangerous than the actual disease! Our body has got the capacity to fight against all infections, when the body is not in a position, we can stimulate the body using suitable homeopathic drugs. Day by day, most of the pathogenic organisms are acquiring resistance to the antibiotics; hence the drug industry is periodically developing new generation antibiotics. When Ciprofloxacin was introduced, it was initially given for the African elephants, and now it is a routine prescription even for the kids. It is said that during Hahnemann's time, the mode of treatment adopted by the orthodox practitioners were brutal and inhuman, and now their system is called modern medicine, which is much more advanced and has excluded all those brutal methods. But the truth is, now they have only changed the procedures by introducing some sophisticated instruments and painkillers, but their mode of approach towards the sick man is almost same. The only one difference is, now the impact of treatment is much more serious than those methods!
Why treating an acute is a challenge?
In the present era, time is a major factor behind several issues. Many diseases like Acid peptic disease, Hurried woman syndrome etc. are having close link with the busy life styles. Due to lack of sufficient time, nobody can take a leave from his or her routine activities. Hence, the main demand from each patient is quick relief of his acute complaints. It seems that quick symptomatic relief with less importance to the side effects is the main motto of present days medical practice. Nowadays eruptive diseases like chicken pox are suppressed by strong medicines so that the victims can restart their routine within a few days. To allow the natural eruptive disease to complete its course is an outdated concept nowadays. Even the educated people are not bothered about the long-term consequences of suppressing such diseases!
During the initial days of practice, a beginner may get more number of acute cases; hence successful management is mandatory to establish a sound practice. In Homeopathy, we have our own tools to manage all types of diseases. The guidelines given by the masters are also available with us. The only necessity is the proper application of the knowledge inherited from them. Now the main difficulty is remedial diagnosis and the systematic follow-up of the case. Compared to other systems, the choice of drugs is more before us; hence the chance of failure in drug selection is also more. For example: There are 272 drugs given for headache in Synthesis repertory. How to select a single drug from this long list of drugs? And there will be a number of drugs covering the common symptoms of the patient, which in turn leads to more confusion. This is the main reason behind the saying “a homeopath needs some extra intelligence for the drug selection.” Here we need the qualitative acute totality of the case, not the mixed totality, quantitative totality or the “forced totality” of the patient. Once we select the similar drug and administer the same in suitable potency and dose, it will be a pleasurable experience for the patient. And for the doctor also, curing a patient from an acute suffering is something that gives great satisfaction. Hence, the challenge before us is to cure the patient rapidly, gently and permanently without causing any suppressions and side effects.
Case taking in acute cases
Case taking is much easier in acutes, because the whole picture of the patient is very clear, causations are definite, modalities and concomitants are prominent. The patient can easily provide the strongest, striking and troublesome symptoms to the doctor by which the true picture of the case is quickly exposed. During an acute episode of illness, the attention of the whole family is on the patient; hence their information is also reliable. However, more importance should be given to direct interaction with the patient. Hence always ask the patient to come directly. Prescribing on the basis of symptoms (usually common symptoms) reported by some family member can definitely lead to failure. Direct interaction is a must for correct remedial diagnosis and disease diagnosis. Disease diagnosis is very important due to several medical and medico-legal issues. Failure of a case without disease diagnosis is surely a negative mark for the doctor than the failure of a case that is already diagnosed.
In case taking of acutes, altered state is more important than the basic features of the patient. The onset, duration, progress and outcome of the sickness has to be considered with due importance to the order of appearance of symptoms. The most important point to be remembered is targeting the presenting complaints; hence the drug selected on the basis of acute totality should also cover the presenting complaints. Each symptom should be completely noted down in order to make it complete. Even a common symptom becomes important when it is qualified with location, sensation, modalities and concomitants. In an acute episode, the constitutional drug of the person is not homeopathic at the moment, but can help us later when the acute drug is not working. There for care should be taken to avoid the mixing of the altered characters with basic characteristics. Past history of the same clinical presentation and its suppression should be inquired to distinguish exteriorization, so that we can change our approach accordingly.
Management of acutes
Managing an acute disease is a knack especially when the patient and his family members are very much tensed about the outcome of disease. This is more during the outbreaks of epidemic due to the panic created by the media, which is the influence of sensational journalism!
While dealing with an acute case, our decision should be quick and wise, because we don't have much time left for a rethinking. Acutes give more agony for the patient because the he is not habituated with the sufferings and it can also affect the day today activities seriously because the sickness is unexpected. Hence, most of the patients demand the doctor for an immediate result. There are different modes of prescriptions; because the similarity may be on different levels, hence there can be a number of similar drugs. There will be overlapping of common symptoms by a number of drugs. All these can lead to confusion in drug selection. But the intelligent physician can easily distinguish the similimum from the group of similar drugs.
The similimum should be selected on the basis of totality of the case. However in practice, many homeopaths use some shortcuts for the selection. A few ways of drug selection are: Causation, Climatic remedies, PQRS, Generals, Acute drug of the constitutional remedy, Favorite remedy, Near specifics, Combinations, Alternation of related drugs, Indicated remedy along with some tinctures and biochemic salts, Drug selected on common symptoms, Routine remedies, Keynote prescription (Allen's three legged stool), Organ remedies etc. Nowadays, a few softwares and charts are also available for the easy selection of drugs in acutes.
· Repeated symptomatic treatment can be dangerous, because it can sensitize the miasms. Hence consider the antimiasmatic constitutional drugs.
· Unnecessary repetition of the simillimum can spoil the case. If repetition is necessary, preferably do the same by plussing method.
· Wet dose is better than the dry dose- Divided doses in water.
· Placebo should be give along with the indicated medicine. Ask the patient to take the non-medicated tabs frequently during an aggravation so that the patients will not go for drugs that can cause suppression. This is more useful for fever cases and painful conditions. But, always rule-out complications or advancement of the disease when there is an aggravation.
· Higher the similarity, higher the potency. If you are very sure about the drug selected, give it in LM potency, or else give the decimal or centesimal potency.
· No frequent repetition in acute skin diseases like impetigo- It can make the condition worse. Hence the best is, one or two doses along with placebo.
· Follow the Hering's law strictly, because our symptomatic treatment may remove the presenting complaints quickly, but another more important system may be involved.
Diet in acute diseases
In aphorism 262 and 263, Hahnemann gives instructions on the diet in acute diseases. He instructs us to satisfy the needs of the patient during an acute disease, of course, within certain limit. However, it should be kept in mind that the specific food item that can affect the remedy should be avoided. The body gets a refreshed feeling by taking a desired item. The slightest hindrances created by these non medicinal food items can be managed by the suitable homeopathic medicines along with the vital force. Apart from the food items, the temperature of the room and other surroundings should be arranged as per the patients’ desire. Most of the doctors advice the patients not to bath during fever. But the fact is, patient should be more hygienic during fever. The old dictum “One man's food is another man's poison” should be kept in mind while suggesting restrictions, because the substance that can affect one person may not affect another one. Remember, unnecessary restriction is more troublesome for the patients than the actual disease!
What to do when the indicated medicine is not working?
While dealing with a chronic case, we have enough time to give the placebo and to do re-case-taking or repeating the same remedy, high potency, intercurrent drug etc. On the other hand, we don't have much time to study the case in acute cases. In fact, acutes are the commonest situation wherein a few among us forget our principles and do all possible means to suppress the presenting complaints and make the patient happy. After giving the initial dose, when the acute totality is same and we are sure about the drug selected, we can repeat the drug preferable in a higher potency. If the drug picture is changed, we will have to consider a new drug on the basis of present totality. Under such situations, the use of drugs like Sulphur, Tuberculinum, Influenzinum etc have saved many cases. Even after trying all possible ways, if the patient is not responding, we will come to a stage of confusion - whether to refer or to take one more chance. This is the situation to take the help of our colleagues or seniors and apply some clinical tips. However, it should be kept in mind that repeated symptomatic treatment can suppress the miasmatic expression and take the wrong direction of cure. It should be also remembered that frequent repetition of a partially similar drug can also spoil the case.
Some clinical tips to handle acutes on certain situations:
· Vomiting: Ipecac 3x, Zingeber Q
· Cough: A mixture of Drosera Q and Spongia Q
· Constipation: Senna Q, Cascar sag Q, Verat alb 3x
· Menstrual colic: Xanthoxylum Q
· Neck pain/stiffness: Lachnanthus 3x, Rhustox 30
· Diarrhea: Elaterium 3x
· Hiccough: Mix 10 drops of cinnamon Q in 20 ml of water. Swallow one drop at a time, followed by another drop. Repeat this for a few minutes till hiccough goes off.
· Loss of voice: Pop can Q
· Toothache in carious teeth: Apply Plantage Q or Kreosot Q
· Apthous ulcer: Gargling of Rhus glabra Q, Sempervivum tect Q
· UTI: Sarsparilla Q, Uva ursi Q
· Abscess: Silicea 6x, Myristica 6c, Hepar 30
· Pain after physical exertion: Bellis per Q
· Sinusitis: Sanguinaria Q, Cassia sop Q
· Acidity: Robinia Q, Zingiber Q
· Severe loud eructations with obstructed feeling: Cajuputum Q
· Umbilical pain in children with worms: Spigelia 30
· Colic: Colocynth 30, in children Cataria nepeta Q
· Rattling in infants: Eridiction Q, Sambucus Q
· Fever: Baptisia Q, Ocimum sanctun Q, Veratrum vir Q, Bell 3x
· Pharyngitis/tonsillitis: Ailanthus Q, Wyethia Q
· Throat irritation: Wyethia Q
· Retention of urine in old age: Solidago Q, Boerrhevia Q
· Asthma attack: Grindelia Q, Pothos Q, Iodoform 3x, Ipecac 1x
· Difficult expectoration: Balsm peru Q, Senega Q
· Acute joint pains with swelling and redness: Apis 3x, Formic acid 3x, Gaultheria Q, Valeriana Q
· Urticaria: Urtica urense Q (internal and external)
· Profuse menses: Millefolium Q
· Migraine: Sanguinaria Q, Melilotus Q, Usnea barb Q, Coffea cruda Q
· Inveterate cases of cough: Mephitis 3x
· Crushed finger tips: Hypericum 200
· Honeymoon cystitis: Staphysagria 200
· Eczema in children: Dulc 200 1dose, Rhus tox 30 one dose
· Weakness after fever: Natrum salicylic 30
· Continuous high fever: Millefolium Q, Tuberculinum 200
· Cough after fever: Eridiction Q
· Prevention of febrile convulsions: Bell 1M, Cicuta 200
· Joint pains after fever (chikungunya): Lycopersicum Esc. 30
· Congestive headache: Usnea barb Q
· Sprains: Ruta 200
If you feel that the case is difficult to manage, take the help of your colleague or refer the case to a higher center. Always refer the case with a detailed reference letter that includes the ODP of clinical features, investigation reports and the name of drugs already prescribed.
Nowadays homeopathy is much criticized because of lack of “scientific proof.” Hence we all are behind the evidence-based medicine, which is mainly based upon the concept of modern medicine. Homeopathy can’t be fully explained using the protocols given by EBM, because EBM does not give importance to the individual feelings of the patients or provers. The most effective way of proving the efficacy of homeopathy is the successful management of cases, because the voice of the real patient is more important than the voice of the so-called scientists. In fact, homeopathy still exists mainly because of the mouth-to-mouth publicity given by those people who got cured successfully by this system.
Dr Muhammed Rafeeque, BHMS, PGNAHI.
Family Homoeopathic clinic