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Continued Homeopathic Medical Education--Homeopathy and Arthritis

CHME
Continued Homeopathic Medical Education
Homeopathy and Arthritis
Pam Mc.Even
Dr.Sharad Shangloo
Dr.G.K.Shangloo
Dr.Sunit Shangloo
Meera Shangloo Homeopathic Research Centre
70/59 Rani Mandi Allahabad India 211003


Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions involving damage to the joints of the body.
There are over 100 different forms of arthritis.[1][2] The most common form, osteoarthritis (degenerative joint disease) is a result of trauma to the joint, infection of the joint, or age. Other arthritis forms are rheumatoid arthritis, psoriatic arthritis, and related autoimmune diseases. Septic arthritis is caused by joint infection.
The major complaint by individuals who have arthritis is joint pain. Pain is often a constant and may be localized to the joint affected. The pain from arthritis occurs due to inflammation that occurs around the joint, damage to the joint from disease, daily wear and tear of joint, muscle strains caused by forceful movements against stiff, painful joints and fatigue.



Classification
Primary forms of arthritis:
• Osteoarthritis
• Rheumatoid arthritis
• Septic arthritis
• Gout and pseudo-gout
• Juvenile idiopathic arthritis
• Still's disease
• Ankylosing spondylitis
Secondary to other diseases:
• Ehlers-Danlos Syndrome
• Sarcoidosis
• Henoch-Schönlein purpura
• Psoriatic arthritis
• Reactive arthritis
• Haemochromatosis
• Hepatitis
• Wegener's granulomatosis (and many other vasculitis syndromes)
• Lyme disease
• Familial Mediterranean fever
• Hyperimmunoglobulinemia D with recurrent fever
• TNF receptor associated periodic syndrome
• Inflammatory bowel disease (Including Crohn's Disease and Ulcerative Colitis)
Differential diagnosis
Osteoarthritis
Osteoarthritis is the most common form of arthritis. It can affect both the larger and the smaller joints of the body, including the hands, feet, back, hip or knee. The disease is essentially one acquired from daily wear and tear of the joint, however, osteoarthritis can also occur as a result of injury. Osteoarthritis begins in the cartilage and eventually leads to the two opposing bones eroding into each other. Initially, the condition starts with minor pain while walking but soon the pain can be continuous and even occur at night. The pain can be debilitating and prevent one from doing some activities. Osteoarthritis typically affects the weight bearing joints such as the back, spine, and pelvis. Unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. More than 30 percent of females have some degree of osteoarthritis by age 65. Risk factors for osteoarthritis include: prior joint trauma, obesity, sedentary lifestyle.
Osteoarthritis, like rheumatoid arthritis, cannot be cured but one can prevent the condition from worsening. Weight loss is the key to improving symptoms and preventing progression. Physical therapy to strengthen muscles and joints is very helpful. Pain medications are widely required by individuals with osteoarthritis. When the disease is far advanced and the pain is continuous, surgery may be an option. Unlike rheumatoid arthritis, joint replacement does help many individuals with osteoarthritis
Rheumatoid arthritis
Rheumatoid arthritis is a disorder in which, for some unknown reason, the body's own immune system starts to attack body tissues. The attack is not only directed at the joint but to many other parts of the body. In rheumatoid arthritis, most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones. Rheumatoid arthritis affects joints in the fingers, wrists, knees and elbows. The disease is symmetrical and can lead to severe deformity in a few years if not treated. Rheumatoid arthritis occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities. No one knows why rheumatoid arthritis occurs and all treatments are focused on easing the symptoms. With earlier diagnosis and aggressive treatment, many individuals can lead a decent quality of life. The drugs to treat rheumatoid arthritis range from corticosteroids to monoclonal antibodies given intravenously. The latest drugs like Remicade can significantly improve quality of life in the short term. In rare cases, surgery may be required to replace joints but there is no cure for the illness.
Lupus
This is a common collagen vascular disorder that can be present with severe arthritis. Other features of lupus include a skin rash, extreme photosensitivity, hair loss, kidney problems, emotional lability, lung fibrosis and constant joint pain.
Gout
Gout is caused by deposition of uric acid crystals in the joint, causing inflammation. There is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate known as pseudogout. In the early stages, the gouty arthritis usually occur in one joint, but with time, it can occur in many joints and be quite crippling. The joints in gout can often become swollen and lose function.
Other
Infectious arthritis is another severe form of arthritis. It presents with sudden onset of chills, fever and joint pain. The condition is caused by bacteria elsewhere in the body. Infectious arthritis must be rapidly diagnosed and treated promptly to prevent irreversible and permanent joint damage.
Psoriasis is another type of arthritis. With psoriasis, most individuals develop the skin problem first and then the arthritis. The typical features are of continuous joint pains, stiffness and swelling. The disease does recur with periods of remission but there is no cure for the disorder. A small percentage develop a severe painful and destructive form of arthritis which destroys the small joints in the hands and can lead to permanent disability and loss of hand function.
Signs and symptoms
Regardless of the type of arthritis, the common symptoms for all arthritis disorders include varied levels of pain, swelling, joint stiffness and sometimes a constant ache around the joint(s). Arthritic disorders like lupus and rheumatoid can also affect other organs in the body with a variety of symptoms.[10]
• Inability to use the hand or walk
• Malaise and a feeling of tiredness
• Fever
• Weight loss
• Poor sleep
• Muscle aches and pains
• Tenderness
• Difficulty moving the joint
It is common in advanced arthritis for significant secondary changes to occur. For example, in someone who has limited their physical activity:
• Muscle weakness
• Loss of flexibility
• Decreased aerobic fitness
These changes can also impact on life and social roles, such as community involvement.
Disability
Arthritis is the most common cause of disability in the USA. More than 20 million individuals with arthritis have severe limitations in function on a daily basis. Absenteeism and frequent visits to the physician are common in individuals who have arthritis. Arthritis makes it very difficult for individuals to be physically active and soon become home bound.[11]
It is estimated that the total cost of arthritis cases is close to $100 billion of which nearly 50% accounts from lost earnings. Each year, arthritis results in nearly 1 million hospitalizations and close to 45 million outpatient visits to health care centers.[12]
Arthritis makes it very difficult for the individual to remain physically active. Many individuals who have arthritis also suffer from obesity, high cholesterol or have heart disease. Individuals with arthritis also become depressed and have fear of worsening symptoms.
Diagnosis
Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by other tests such as radiology and blood tests, depending on the type of suspected arthritis. All arthritides potentially feature pain. Pain patterns may differ depending on the arthritides and the location. Rheumatoid arthritis is generally worse in the morning and associated with stiffness; in the early stages, patients often have no symptoms after a morning shower. Osteoarthritis, on the other hand, tends to be worse after exercise. In the aged and children, pain might not be the main presenting feature; the aged patient simply moves less, the infantile patient refuses to use the affected limb.
Elements of the history of the disorder guide diagnosis. Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms. Physical examination may confirm the diagnosis, or may indicate systemic disease. Radiographs are often used to follow progression or help assess severity.
Prevention
While neither Rheumatoid arthritis nor osteoarthritis can be completely prevented, one can reduce the risks by becoming physically active, participating in physical therapy, losing weight and eating healthier. All individuals who have pain in the joints should seek early diagnosis because the earlier the treatment is started, the better is the prognosis.
Treatment
There is no cure for either rheumatoid or osteoarthritis. Treatment options vary depending on the type of arthritis and include physical therapy, lifestyle changes (including exercise and weight control), orthopedic bracing, medications. Joint replacement surgery may be required in eroding forms of arthritis. Medications can help reduce inflammation in the joint which decreases pain. Moreover, by decreasing inflammation, the joint damage may be slowed.
Physical Therapy
In general, studies have shown that physical exercise of the affected joint can have noticeable improvement in terms of long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person
Individuals with arthritis can benefit from both physical and occupational therapy. In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases. Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focusses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can teach you how to reduce stress on your joint from daily living activities. Occupation therapy can also teach you how to modify your home and work environment so that you do reduce movements that may worsen your arthritis. There are also assist devices available that can help you drive, getting a bath, dressing and also in housekeeping labors.
Occupational therapy can help you do everyday activities without worsening pain or causing joint damage. The techniques can help you distribute pressures to minimize stress on any one joint. Ways to accomplish daily living tasks are made easier







Arthritis And Homeopathy

As we grow older our bodies begin to degenerate and we are surrounded by many diseases. Arthritis includes a set of more than eighty auto immune diseases. Some of the forms of Arthritis cripple the patients but they are not at all life threatening.

Depression is one factor that is strongly associated either with osteoarthritis or rheumatoid Arthritis. According to medical research as many as one half to a third of the elderly population has arthritis and approximately 20 % of the population suffer from depression.

RA is considered to be the most severe form of Arthritis and patients may experience debilitating symptoms characterized by severe joint deformation ,anemia, weight loss ,fatige etc. where as people with Osteoarthritis may have symptoms leading to decreased mobility and diminished quality of life.

According to Homeopathy ,arthritis has a mixed miasm or sycotic taint combined with pseudo psora

Treating depression can relieve the symptoms but finding the right anti miasmatic remedy will control the progress of the disease and can change the RA factor positive and C- RP positive to negative.

When the patent comes to you then you should ask him to go for a digital X ray, RA factor which should be a quantitative one , ALSO Trtitler test. This will held you in establishing in your patients mind what your medicine is doing in his body.



Apprehensions of the patient

1. Will the homeopathic medicine work like a pain killer?
No- Homeopathic medicine will not work like a pain killer but can reduce the pain and can decrease the number of painkillers required in a day finally leading to no pain killers at all.
2. Do I have to stop taking allopathic medicines ?
The patient need not stop taking the pain killer as soon as he starts taking the homeopathic treatment. Start with the homeopathic medicines along with the allopathic medicines and the pain killers. There should be the difference of 1 hour between the allopathic and the homeopathic medicines. After one week the patient should access himself. If he is finding improvement .Then He should reduce the dose of the pain killer and allow his body to settle down.
Suppose a patient is two painkillers a day – one in the morning and one in the evening. Then he should take the morning dose and should wait till he is able to bear the pain. Then he should take the evening dose either in the night or anytime he feels that he is not able to bear pain. Gradually the doses of painkiller will be reduced and he will start taking pain killers once a day, then every alternate day and so on and so forth. Then a time will come when he will not take any pain killers at all and he will be only on homeopathic treatment.
Suppose the pain starts between the first dose of the pain killer and the second dose. Then the homeopathic medicines can be taken intercurrently and as frequently when required to reduce the pain according to the symptoms.
For example.
If the pain has increased due to the on set of stormy weather -- take Dulcamara 30c . If the pain had started after long walk. Then if the pain is better hot application take Rhus tox 30. If the pain is < movement take bryonia. If you presume there is an injury to the joint take Arnica. And so on and so forth
3. Why not to go for joint replacement therapy?

One should not take joint replacement therapy as easy way out to deal with certain kinds of arthritis. But , one should always keep in mind that the disease lies inside and should be dealt holistically. Just replacing the joint is not the solution to this problem. Because the bones in which the artificial joint is nailed also becomes weak in the due course of time. Besides that there are may other complications as well.



Homeopathic approach to Arthritis treatment
1. Constitutional Medicine
As you all know how the constitutional medicine is selected for any of the problem .I will not go deep into it. But I will let you know the protocol how the medicine should be given, adjusted with other remedies from time to time and repeated to give the best result in more patient perceptible way.
We have seen in our clinical practice that if you give a constitutional remedy and wait for 15 days or a month. The patient will run away. Because the patient gauges the progress of disease with the decrease or complete removal of symptoms of pain and stiffness only.
But the constitutional medicine gives relief to the patient as a whole and also gives relief to patient as a whole and some relief in the pain and stiffness which the patient is not able to relalise.

2. Anti –Miasmatic medicines

It is very important to give a anti- miasmatic remedy undercurrent with the symptomatic remedies. Especially a nosode.
3. Homeopathic remedies
4. Mother tinchures
5. Batch Flower Remedies
6. Biochemic medicines

List of Medicines most effective

Homeopathic medicines in potency

Level One medicine

1. Bryonia
Besides other symptoms the distinguishing symptom is pain in the joints or body < movement and even changing sides in bed.
2. Rhus Tox
Pain all the joints worse < first motion better motion .Symptoms< exposure to cold.
3. Arnica Montana
Bruised sensation is the key feature. Along with soreness and problems after inury. Especially suited to the patients after they have a fall or slipped in the bathroom. Had an inury whiel walking around.

4. Ruta G
Injury to the bone or the joint is the key feature. Swelling of the joint even without injury is a symptom to be prescribed on.

5. Calcarea Carb

Especially suited to the patients who are overweight
6. Causticum

Sciatica with numbness , paralysis of single part. Burning in Joints. Unsteady walk and easy falling .

7. Cimcifuga


8. Colchicum


Level Two Medicines

1. Osteoarthitis Co
It is made from synovial liquid of arthritis - joint. A proving of the Osteo Arthritis nosode of the hip was read in the 18 th All India Homeopathic Conference at Madras on 10th October 1970 .The two prepairations of the osteo arthritis nosode are done from the synovial liquid of joints. The osteo arthritis Nosode that originated from Dr. Foubister comes from the knee of a patient suffering from an osteo arthritis affection and the other stock from the hip of a similar case. Here is a nosode which acts towards the osteo Arthritic direction.

State of Stupor and indifference to others. Extreme weakness with somnolence in the afternoon and profound sleep. Weakness < in the morning when waking up .Great desire to sleep with deep sleep in the night.

Aggravation from first motion , night. Better by prolonged movement. worse right side.

Mind – state of Indifference , nonchalance. Idleness ,no desire to work .Irritability worse towards evening .Indecision , needs relaxing.
Extremities- Swelling of the right wrist. Pain in the right shoulder. Muscular pain of the right hip. Temporary redness and swelling of the right shoulder .Redness and swelling of the right fore arm and right wrist. Pain aggravated by first movement , ameliorated by continued movement. Pain of the Achilles tendon.


2. Sycotic Co
From non lactose
3. Kalmia

4. X-Ray
Rheumatic pain trembling of limbs. Generalized pain in the limbs,sciatica , Neuralgia. Sensation of electric current in the limbs
5. Kali Iodide


Homeopathic Mother Tinctures

1. Gaultheria Procumbens

It is a very good remedy for Inflammatory Arthritis , rheumatism,sciatica and other neuralgia.
The most prominent symptom is all kinds of joint pains accompanied by gastric disturbance and especially there is nausea and vomiting.

It is generally given in mother tinchure form . Its oil contains methyl salicylate.


2. Guacum Sanctum/ Officinale

It is one of the Hahnemanns anti psoric remedy in gout is best known as a remedy in gout and rheumatism .Homeopathic proving have developed and defined the sphere of its utility in all these respects and many more.
Vermey treated a women, ,who for several years had a frequent recurring gouty inflammation of knees, after china failed to relief. Guacum finally gave the relief.
In the same women the patient injured the same knee. .Under guacum the swelling broke and the pain was relieved. But the abscess formed at same time on the upper thigh. The pain became unbearable and the patients husband begged for more medicine which was provided to the patient.
On two later occasions Dr. Verwey saw that Guacum acted in the same way on scrofulous abscess.
Its chief action is on the fibrous tissue.
Sensitiveness and aggravation from local heat. Contraction of limbs, stiffness and immobility. Feeling that he must strech.
Rheumatic pain in the shoulder arms and hands. Pain in the legs with stiffness.


3. Jacaranda Caroba

There are several species of Jackranda and it has a reputation of curing syphilis. It is remedy for the rheumatism with the importance of urinary symptoms. Morning sickness and rheumatic symptoms.
Urinary and sexual symptoms are also important.
Rheumatic pain is there in the right knee. Weakness of lumbar region . Morning soreness and stiffness of muscles . Gonorrheal Rheumatism.Gonorrheal and syphilitic arthritis.


4. Nyctanthes Arbor – tristits
It is a small tree from the Jasmine family. It has brilliant highly fragrant flowers, white and yellow, which do not expand until evening and which fall out about sunrise.
Its key symptom is bilious and obstinate remittent fever.
The other features are sharp shifting pain .
Synovitis
Pain goes from the back to the thighs.




5. Phytolacca D
According to Raffinesque the ash of the plant contains 45% of caustic potash and the plant contains besides an acid, Phytolactic acid ,which is closely allied to Malic Acid.
Kaili Iod is the nearest analog, especially in syphilitic rheumatism. Mercury is closely related, phtolacca has been called by some physicians vegetable mercury.Both remedies haves many symptoms in common.
Shooting pain in the right shoulder with stiffness and inability to raise the arm. Rheumatic pain < morning. Pain fly like electric shock, shooting, lancinating pain shifting rapidly.{ Same as Pulsatilla and Kali bich}.Painful hard shiny swelling of finger joint. Hips and thigh pain on change of weather. Sharp Cutting drawing pain in the hip, legs drawn up, can not touch the floor. Syphilitic sciatica. Aching of heels , relieved by elevating feet. Pain like shocks. Pain in legs .patient dreads to get up.Feet puffed. Pain in ankles and feet. Neuralgia in toes.


6. Stellaria Media

The first mention of Stellaria Media by F.H. Brett gave an experience with tinchure applied externally in case of his wife to enlarged inflamed gouty joints and in his own case of painful aching great toes. In each case a few applications removed the trouble.
Brett was led to this use by having heard a rumor that “chickweed poultices” were good for gouty joints. F. Kopp published a proving of the tinchure on himself. .Koff took frequently repeated doses of the tinchure and also chewed some of the weeds. Then pains induced were of a rheumatic character and were so severe that they have to be antidoted with Nux and Bryonia.
Kopp confirms Bett observations in the value of external application of Stellaria Media. Internally he gave Stellaria Media 2x.The most prominent symptom, apart from the rheumatic effect ,was the pain , swelling and soreness of the liver.
Joints are stiff. Rheumatoid pains in different parts of the body. Sharp pain in small of back, over kidney in gluteal region , extending down the thighs. Pain in shoulder and Arms.Synovitis. Bruised feeling. Rheumatic pain in calves of legs.
.
Back- Rheumatic pain across small of back, worse bending. Loins stiff and sore. Dull pain under right scapula.


BioChemnic Support


1. Calcarea Phos6x
The sphere of the Phosphate of Lime includes all bone diseases, whether due to some inherited dyscrasia or to defective nutrition in osseous and other structures dependent upon a proper distribution of lime molecules in the body. It is the bone cell-salt. Without this element, no bone can be formed and hence it is a valuable remedy in arthritis . In convalescence after acute and chronic wasting diseases, it acts as a tonic by building up new red blood corpuscles and by restoring the lost vitality. Aids the union of fractured bones. Rheumatism of the joints.Cold, change of weather, motion, getting wet, generally aggravates symptoms. Relieved by rest, warmth and by lying down


2. Caclcarea Flour 6x
EXTREMITIES: Ganglia or encysted tumours at the back of the wrist. Gouty enlargements of the joints of the fingers. Exostoses on the fingers. Chronic synovitis of knee-joint.

MODALITIES:
WORSE- During rest, change of weather
BETTER- Heat, warm application



Batch Flower Remedies Support



1. Cherryplum
Desperation, fear mind gives the way. Verge of Nervous breakdown. Fear of suicide .Fear of losing control or reason. Fear of insanity .Possibility of violent impulses.

2. Carb apple

Feeling of Despair, Feeling mentally and physically unclean .Despondent if treatment fails. Have trivial thoughts.
3. Elm

For those who although fulfill their responsibility in life becomes despondent at times ,feeling that the responsibility is too great .This causes weakness and debility.

4. Honey Suckle

For those who dwell too much on memories and event of the past. Great naustralgia homesickness. Especially suited for widows ,orphan and senior citizens who have to live alone.

5. Red Chestnut
Fear and Over anxiety about the welfare of others. Fear that calamity may befall them. Negative thoughts and apprehensions; especially of parents towards their children.

6. Star of Bethlehem

Shock in any form due to bereavement, accident, or a distressing sight .Help bereaved persons in coping up with their grief and sadness


7. Willow

Resentful and bitterness .Blames everyone else but himself.

Protocol of Homeopathic Treatment


1. Makeing the patient comfortable.
The patient has to be made comfortable that it is a disease for which a long term treatment is required and the patient should have patience.
2. Talking about his disease
The disease should be discussed with the patient and he should be informed that it is not a life threatening disease .
3. Making him understand that treatment will continue for long
The patient should be made to understand that the treatment should be continued for long. And he should be mentally prepared for it

4. Trasparency in treatment by the help of X-ray, RA Factor quantitative test and Also tritiler. Serum Uric Acid.
There should be a transparency in treatment. The progress of the diseases should be accessed by the tests and which will prove to the patient that medicine is not acting as a painkiller but also slowing the progress of Disease.

5. How it is different form pain killers?
Patients who are on painkillers or prolonged allopathic treatment. Their medicines should not be withdrawn at the first instance. The homeopathic treatment should be continued with the allopathic treatment. After a week or 15 days treatment , the patients condition should be accessed . .If patient says that he is feeling more improvement with both the homeopathic and the allopathic medicines together then the dose of Allopathic medicines should be reduced to half.
Example-
A patient is taking allopathic medicines three times a day which includes the calcium supplement and the pain killers and other uric acid decreasing medicines. Then there are two ways to decrease his doses. One the quantity of the medicines are reduced to half but the dosing is the same the other is the dosing is reduced.
You can try either of the two. If the patient says there is relief for only two to three hours and again the pain and the other problems increase. Then you require reducing the mg of the medicines. But if there is an overall improvement then the dosage of the medicines should be reduced. And the dose of afternoon or night should be missed.
Once the patient is set on this schedule then the doses or the mg should be further reduced.
And slowly the allopathic medicines should be should be stopped completely .And the patient should be on homeopathic treatment. Then too the patient should be given the liberty that if there is severe pain which is not controllable by homeopathic medicines then he is allowed to take the painkiller which he was previously taking.

7. Why not to go for Joint replacement?
Joint replacement should be taken as a last resort rather than the first option. Joint replacement just deals with the specific joint not the disease in the whole body.
Once one joint is replaced then the disease moves to the other joint and especially diseases moves from the bigger joints to the smaller joints and till the proper homeopathic treatment is not given the problem is not solved.

8. Prescription
In these cases we follow a specific protocol, rather than giving a single remedy
We do not give a mixture of remedies but in a prescription 15 day we have


a. Constitutional medicine
b. Miasmatic remedy
c. Pain relieving remedies
d. Emotional remedy
e. External application

Constitutional remedy should be selected on the totality of symptoms as we all do.
Then there is a miasmatic remedy which should be a nosode or an imponderablia.
Like x ray, Osteoarthrits Comp.,Sycotic Compound, etc.
Then comes the symptomatic remedy. It may be rhustox, bryonia , kalmia, ledum etc.
According to the symptoms.
This is the remedy which should be freely given to the patient . If the doctor is not in touch with the patient then the patient should be given a chart along with the names of the medicines.
Like injury to any part take Arnica, If injury to the bone take ruta, if the pain increases due to cold weather take dulcama, if the pain is worse first motion on and better motion and relieved by hot application and if relieved by cold take pulsatilla. If pain < changing sides in bed then take Bryonia.
This will help patient to reduce the consumption of pain killers. These medicines should be taken in 30 c potency and should be repeated as frequently as required. Even at a gap of 5 minutes till the improvement starts. Then the duration of the dosing should be increased accordingly.
If this measure fails to give relief to the patient then only the help of the help of the painkillers should be taken than too in minimum quantity.

For emotional support. If the mental factors are too strong and you feel that there is a need to address it separately. Then the help of the Batch Flowers should be taken.
It should be given in 30c potency and should be given 10 to 20 drops four times a day in half cup of water regularly. Till the mental state of the patient becomes normal.
If again it is required it should be recontinued.

In case of swelling of the joint ,pain , tenderness and sensitive to touch. The external application can be prepared by mixing
In each 15 ml liquid
Arnica Mond 1.66ml
Symphytun 1.66 ml
Belladona 1.66 ml
Gaultheria oil .50 ml
Eucalyptus Oil 1.33 ml
Turpentine Oil 1.33ml
Mustard Oil QS

Dosing structure
Constitutional Medicine should be given in 1000c – one dose in a week or 15 days
Miasmatic medicine should be given in 200c – one dose a week.
Symptomatic Remedy – in 30c potency
Biochemic in 3x or 6x-
Batch Flower – in 30c .- 10 to 20 drops three to four times a day as required
External Application- Once to four times a day as required.






9. Allow patient to take pain killer during the course of homeopathic treatment.


10. Monitoring of the patients condition by symptoms and diagnostic test and tools
Monitoring of the patent should be done in one week with the help of symptomatic change. If the fingers of the hands are curved or if the legs are cured then the curvature should be meas








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