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Date posted: May 5, 2012

Brief description of few cured cases of Mahesh Bhattacharyya Homoeopathic Medical College & Hospital
Dr Rajat Chattopadhyay

Case No. I
Abstract: A diagnosed case of Parotid gland tumor and advised for surgery but taking Homoeopathic medicine the swelling disappeared and right now the patient is quite normal and healthy.

Key Word: Parotid gland tumour; Surgical treatment; Thuja; Paediatric Department; Homoeopathic Medical College & Hospital; Indications; Repertorial Rubrics; Calcarea carb; Relevant; Documents.

A diagnosed case of right sided parotid gland tumour, of 3yrs aged female pt. returned from teaching hospital (N. R. S. Medical college & hospital, Kolkata), when surgical treatment was advised.

At first Thuja oc. 200/1dose was prescribed on 05/02/2001, by junior doctors (probably on the background of strong sycotic family history and others).

There was no improvement till June of the same year.

Then the case was referred to my Paediatric OPD of Mahesh Bhattacharyya Homoeopathic medical College & Hospital. The thorough case taking was done.

The striking indications are:

  • Child was fond of seeing the scenes of cruelty in cinema but become very much afraid of that.
  • Milk intolerance.
  • Sour smell of perspiration.
  • Swelling of right side of parotid glands.

Repertorial rubrics selected are:

  • MIND: Cruelty, brutality, inhumanity: children cannot bear to see cruelty in cinema.
  • GENERALITIES: Food, milk, agg.
  • PERSPIRATION: Odour, sour.
  • FACE: Tumour, cystic, parotid gland right.

Medicine Prescribed

03/07/2001: Calcarea carb. 200/1dose.

02/09/2001: Calcarea carb. 1M/1dose.

10/12/2001: Calcarea carb. 10M/1dose.    

Note: All of the relevant documents are kept in the Government Hospital. For any query mail me through the above email address. We have also video clippings of the present state of the patient. 

CASE – II 

Thuja Occidentalis in Polycystic Ovarian Syndrome: Case review with its understanding in the light of Homoeopathic Philosophy 

Abstract
A middle aged female patient came with irregular menstruation and the investigations suggest PCOS. After going through the detail of the patient, Thuja occidentalis prescribed and the patient is cured (as per USG report).

Key words
PCOS, Organon, Aphorisms, Miasms , Similimum, Holistic, Nosological, Psora, Sycotic, Iatogenetic, Characteristic totality, Rubric,

About the disease:
The most common cause of hyperandrogenism and hirsutism is PCOS. The association of amenorrhoea with bilateral polycystic ovaries first described by Stein and Leventhal in 1935 and was known for Stein Leventhal Syndrome  for decades. In the past all the clinical diagnosis made on the triad of hirsutism, amenorrhoea and obesity. Later on it is researched out that PCOs has an extremely heterogenous clinical picture and is multifactorial in aetiology.

This complex disorder is characterized by excessive androgen production by the ovaries/adrenals which interferes with the growth of the ovarian follicles. Therefore PCOS is a state of androgen excess with chronic anovulation. The incidence varies between 0.5 – 4%, more common in infertile women.

Diagnostic Criteria:

                       MAJOR                                                                     MINOR

            Chronic anovulation.                                                    Insulin resistance.
Hyperandrogenemia.                                 Perimenachal onset of hirsutism & obesity
Clinical signs of hyperandrogenemia.                           Elevated LH – to – FSH ratio.
Other etiologies excluded.                           Intermittent anovulation associated with
hyperandrgenemia(free testosterone, DHEAs)

Hirsutism : In United States it is common in 70% of the patients with PCOS where as in Japan it is only 10 – 20%.

Menstrual Dysfunction:
Oligomenorrhoea to amenorrhoea are the common finding in PCOS. As a rule the patient of PCOS exhibit anovulation. Even in hyperandrogenic women with regular menstrual cycles, the rate of anovulation is 21%. Severe acne in teen age years appears to be an true indicator of PCOS.

Obesity:
It is found in 50% of patients with PCOS. The body fat is usually deposited centrally(android obesity) and a higher waist to hip ratio indicates an increased risk of Diabetes mellitus and Cardiovascular diseases. Apart from excess production of androgens, obesity is also associated with reduced SHBG(sex hormone binding globulin). It also induces insulin resistance and hyperinsulinaemia which in turn increases the gonadal androgen production.

Insulin resistance and hyper insulinaemia: These are very common in the patient of PCOS.

Abnormal lipoproteins: Very common in PCOS and include elevated total cholesterol, Triglycerides, LDLs , low levels of HDLs and apoprotein A – I. The most important factor is decreased levels of HDL2alpha.

Acanthosis Nigricans: It is considered as a marker for insulin resistance in hirsute women. This is characterized by specific skin changes due to insulin resistance. The skin becomes thickened and pigmented. Nape of the neck, axilla, inner thighs are the commonly affected site.

Hair An Syndrome: Women with severe insulin resistance sometimes develop this type of syndrome consisting of hyperandrogenism, insulin resistance, acanthosis nigricans.  

Pathophysiology
Exact Pathophysiology is not clearly understood. The several theories can demonstrate the Pathophysiology:-

Hypothalamic – pituitary compartment

  • Increased pulse frequency of  GnRH
  • Increased pulse frequency of LH(Leptin, a peptide which is secreted by fat cells and ovarian follicles in presence of hyperinsulinaemia may be responsible for this)
  • GnRH is preferential to LH rather than FSH
  • Increased pulse frequency & amplitude of LH results in tonically elevated level of LH
  • FSH level is not increased due to negative feedback effect of chronically raised oestogen & follicular inhibin
  • Increased free oestradiol due to reduced SHBG bears positive feedback relationship to LH
  • The LH : FSH is increased.

Androgen Excess
Abnormal regulation of androgen forming enzyme(P450 C17) is thought to be responsible for excess production of androgens from ovaries and adrenals.

Ovary – excess production of androgen due to

  • Stimulation of theca cells by high LH,
  • Enzyme hyperfunction,
  • Stimulation of the cells by IGF- 1(insulin growth factor 1)
  • Adrenal – Excess production of androgen due to
  • Enzyme hyperfunction(P450 C17)
  • Stress
  • High Prolactine level.

Systemic Metabolic Alteration

  • Hyperinsulinaemia
  • Hyper prolactinaemia

Investigations:

  • Sonography – Trans vaginal sonography is more useful in obese patient.Increased numbers of peripherally arranged cysts are observed.
  • LH level is elevated.
  • LH : FSH ratio is altered.
  • SHBG level decreased.
  • Serum testosterone and DHEA – may be marginally elevated.
  • Serum insulin level elevated.
  • Laparoscopy

Long term risk of a patient suffering from PCOS

  • Endometrial Carcinoma – The risk is greater in non obese and the patients who have not taken the OCPs. In chronic anovulatory patients with PCOS, persistently elevated oestrogen levels uninterrupted by projesteron increase the risk.
  • Ovarian carcinoma.
  • Carcinoma of breast.
  • Diabetes mellitus.
  • Hypertension and cardiovascular diseases due to abnormal lipid profile.

Homoeopathic understanding of pcos
“It is possible to find in the Organon the highest wisdom and greatest foolishness according to the natural tendency of reader.”                                       — August Bier.

I can’t restrict myself to use the very famous quotation of August Bier to write down about the homoeopathic perceiving of PCOS. Like the beginning, if we go forward to few more quotations of our Great Masters of homoeopathic philosophy, then it will be better to realize the fact:

APHORISM – 80
….the psora, the only real fundamental cause and producer of all other numerous, I may say innumerable forms of disease …..  under the names of nervous debility, hysteria, …….epilepsy and convulsions of all sorts

….softening of the bones, scoliosis and cyphosis, caries, cancer, fungus haematodes, neoplasms, gout, haemorrhoids, ……haemorrhage from stomach, nose, lungs, bladder and womb, of asthma and ulceration of the lungs…….deafness, cataract, …… Urinary calculus, paralysis……

APHORISM NO – 205
Homoeopathic physician never treats one of these primary symptoms of chronic miasms by local remedies.   Homoeopathic physician never treats one of their secondary affections that result from their further development by local remedies.

FOOT NOTE(205)- EXAMPLE
If this dynamic remedy should indeed suceed in freeing the affected part of the body from the malignant ulcer locally, the basic malady is thereby not diminished in the slightest,

    …….the preserving vital force is therefore necessitated to transfer the field of operation of the great internal malady to some more important part (as it does in every case of metaschematism)

FOOT NOTE(205)
Without previous cure of the inner miasm (6th ed) when cancer of the face or breast is removed by the knife alone ……….   something worse ensues, or at any rate death is hastened.

But the old school still goes blindly on in the same way in every new case, with the same disastrous results.

So, from these important quotations it is quite evident that we should not bother with the nosological diagnosis only. The cause of the cause is to be searched out by keen observations and exhaustive case taking. The clues may remain in the family history, past history or in the individual’s individuality (caharacteristics), socio – cultural – environmental field etc. and then only it can be claimed as true anamnesis of the case. The concept of local maladies and the surgical removal of it are the basic misunderstanding of the disease prevailing in the medical field. The patient’s high susceptibility to the disease or the miasmatic tendencies of the patient in favour of formation of PCOS or severe insult found in the anamnesis which has hurt the individual to a serious concern or the  continuous stress with tension /grief / mortification / reserved displeasure or even the iatrogenic factor and in few cases some mechanical factor for prolonged period are the real causes to be investigated for reaching to the similimum. The following points to be remembered-

  • Loclal disease cannot be considered as local one without considering the whole – the basic philosophy of Homoeopahty 
  • Even if the remedy given dynamically to the patient as a local one without considering the whole – then we are in the wrong way.
  • Surgical removal cannot cure the inner disease
  • Without curing the inner miasms with the suitable similimum any type of external application or surgical removal are the futile efforts.
  • To cure a chronic disease, the physician has to go to the depth of the disease with his unique case taking processes which will ultimate individualize the case.
  • To know the fundamental cause one should have clear conception of miasm according to our master Samuel Hahnemann.
  • To know the miasm one should have sound knowledge of the symptomatology of the three different miasms.
  • The deeper understanding of miasms and their symptomatology cannot only be ascertained theoretically from our masters, but rather, it is a type of perceiving in daily clinical practice and by keen observation.
  • Mechanical attitude to the disease is still prevailing as before. Though the modern medicine now claim to be holistic but still it differs from homoeopathic concept of holism in therapeutic concept.

The disease cannot be under the domain of any one miasm. In the Pathophysiology part of the disease it is seen that the real cause is yet to be known till date and the few hypothesis made. We cannot forget Psora in this disease because in all of the hypothesis the basic factors remain in the irregularities of the function of endocrine system. The excessive discharge or the less discharge are the factors which are created due to that functional abnormalities. The Pathophysiology and the symptomatology differ in the each patient and it is to be perceived from the Homoeopathic view point that it is not the disease that it will decide to represent its manifestation rather it is the individual’s character, miasmatic back ground, hereditary influences, environmental factors in the wide sense and other accessory circumstances which predetermine the form of manifestation in an individual. So, every thing is predetermined considering all the above factors and those factors are also can be modified to such extent depending on the consistency and the intensity of the modifying factors. It is quiet evident that all the symptomatology under the PCOS can not be manifested in each patient and now it is clearly understood that the patient with sycotic predominance will present the sycotic symptology of the disease and the syphilitic predominance with the syphilitic features and so on.

In case of mixed miasmatic back ground(which is almost common to all cases now a days) the feature of that miasm which is most prominent that time can be seen in conjecture with the symptoms of other miasm in less intense form. In the case taking part of PCOS the emphasis should be given on the medical history, Iatrological history, marital and obstetrical history, sexual history, social history of the patient and the mental as well as physical make up of the patient should be observed with deep insight and utmost sincerity.

 At last, here is a small old case of diagnosed PCOD for sharing my view. In my short clinical practice I have got few good results but I have failed also and those failure cases showed me the way of perceiving the disease in the true sense. It is to be mentioned that intentionally I have put the old case before you because the documentary evidence of other few cases are not the complete one like this case. 

Case Proper
A patient named Dipali Majumdar, aged about 27years, unmarried female, assistant of an old allopathic physician had been suffering from irregular and painful menstruation and diagnosed as a case of bilateral polycystic ovarian disease. At first the lady consulted with the physicians of the modern school of medicine but without getting any satisfactory result. Then she was advised by the old physician to consult with the homoeopathic consultant. The lady came to me for consultation regarding her disease.

The short description of her case is as follows:
PRESENT COMPLAINTS – Irregular, painful menstruation for last 3 years, character of blood being clotted, blackish and scanty in amount.

  • No significant past history.
  • Strong sycotic family history.

HOMOEOPATHIC GENERALITIES –

  • Physical constitution – short but stout with dark complexion.
  • Chilly patient; general aggravation in winter.
  • Appetite – good.
  • Desire for egg, fish, extra salt, salted food++.
  • Intolerance to onion++.
  • Moderate thirst for large quantities at long interval.
  • Stool hard, occasionally with mucus.
  • Urine clear at regular interval.
  • Sleep sound.
  • Dream of dead persons (specially of her dead father), falling from the height++.
  • Tongue – large, flabby and moist with little whitish coating & imprints of teeth.
  • Palm – warm & moist.
  • Teeth have irregular alignment.
  • Mind -       Co-operative but suspicious.
  • Dull weak memory, cannot narrate her problem properly.

Investigations

  • 02/07/2001 – USG of Pelvis – Multiple cysts in both ovaries. (Sonologist – Dr. Lipika Sen, MBBS, DMRD)
  • 01/04/2002 – Blood report
  • Hb – 11.6 mg%, WBC – 7900/cumm
  • Neutrophil – 65%, Lymphocyte – 29%
  • Monocyte – 01%, Eosinophil – 05%, Basophil – 0%         ESR – 48mm (1st hour)
  • [Pathologist – Dr. S.K.Bhattacharyya, MD (Path)]
  • 02/04/2004 – T3 – 98ng/dl
  • T4 – 6.42mcg/dl
  • TSH – 5.49uIU/ml
  • [Pathologist – Dr. K.N.Sirkhell, MD (Path)]
  • DIAGNOSIS –   Bilateral polycystic ovaries. 

CHARACTERISTIC TOTALITY

Mental generals –

  • Mentally dull
  • Weak memory, with difficulty to express her troubles.
  • Suspicious

Physical generals –

  • Dream of falling from height
  • Dream of dead persons
  • Dream of his dead father
  • Chilly patient
  • Aggravation from onion
  • Craving for salty food

Particular Symptoms -

  • Painful menstruation
  • Character of the menstrual blood – clotted, black.

  Rubrics taken for repertorisation

  • MIND, DULLNESS, SLUGGISNESS, difficulty in thinking and comprehending
  • MIND, SUSPICIOUS
  • MIND, MEMORY; Weakness of, expressing one’s self, for
  • SLEEP, DREAMS, Dead relatives
  • SLEEP, DREAMS, Dead of the
  • SLEEP, DREAMS, Falling from high places
  • GENERALITIES, WINTER in
  • GENERALITIES, FOOD, onions agg.
  • STOMACH, DESIRES, salt things
  • GENITALIA FEMALE, MENSES, painful, Dysmenorrhoea

Result of repertorisation
Lycopodium and Phosphorus scored highest & got 15 each, covering the seven symptoms out of ten symptoms.

Thuja got 13 marks and covered the eight symptoms out of ten symptoms.

Comments

  • Lcopodium and Phosphorus scored highest & got 15 each, but Thuja covered the eight symptoms out of ten symptoms. After consulting with Materia medica, Thuja is preferred to be prescribed first. Typical sycotic background, sycotic constitution, chilliness of the patient gave more importance to prescribe Thuja.

Prescriptions : 12/06/2002 -  Thuja occidentalis 30 / 4 doses OD

Patient was advised to come after 45 days.

First two months there was no such improvement, but in general there was no aggravation and patient was in good condition. Her appetite, sleep, thirst all were normal.

After two months the painful menstruation was not so severe as it was in the past. The general feeling of the patient was much better. The character of the blood was also changed from black to reddish and there was no clot (in the last menstruation).

Since after the first prescription only placebo was prescribed in different form from time to time.

On 10/01/2003 the menstruation became again painful with little clots with the flow, but the general feelings of the patient was better. Thuja 200 / 1 dose was prescribed.

Since then for four months placebo was given and the patient was totally symptom free. The menstruation was regular in time, the character of the blood was red with no clot, no pain during menstruation.

Ultrasonography done on 10/05/2003, and study of uterus & ovaries appeared within normal limits with no evidence of SOL in uterus nor any cyst seen at ovaries. [ Dr K N Chakraborty, MD(Path) was the sonologist]

Since then till today patient is better and there is no complaints of irregular or painful menstruation.

Comments

3 Responses so far.

  1. Dr Amit Agrawal says:

    Sir, thank you for enlightening on PCOS with references from Organon and also a case study illustrating it. However, this is to ask the author that has proper consent been taken from the concerned patient before giving out the names?

  2. Dr.G.Srinivasulu says:

    The case documentation is the back bone of homeopathy since its inception.Homeopathy stood the test of time,criticism and skepticism due to to it’s intrinsic merit and its ability in demonstrating the healing properties in the sick individual ( biological model rather than physico-chemical model). Peter Fisher, Editor, Homeopathy emphasized the need of safeguarding the art of case taking by systematic case documentation and its publication.
    I appreciate the efforts of Dr.Rajath in this area.

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