Hahnemannian Proving and Clinical Verification of Caesalpinia Sappan
Dr Mohamed Muneer MD(Hom)
Name : Caesalpinia Sappan
Source : Vegetable Kingdom
Family : Caesalpiniaceae
Vernacular Name : Sappannam
Parts Used : Stem- Heartwood
Aim of study
- To introduce a new drug (Caesalpinia sappan) into the Homoeopathic Materia Medica
- To elicit the symptomatology of the same through Hahnemannian drug proving
- To verify the pathogenesis produced during drug proving and establish its therapeutic efficacy.
- To verify the pathogenesis produced during drug proving and establish its therapeutic efficacy.
- To apply statistical methodology in clinical verification.
- To find appropriate place for its symptoms in Synthesis Repertory.
Proving of caesalpinia sappan
The Homoeopathic Materia Medica contains about 3712 medicines,18 of which more than 2000 are derived from plants plant origin substances, about 400 are from animal or biological products, approximately 1000 are from chemicals or minerals and the rest are from certain inert substances in crude state, physical energies such as light, X-ray etc. According to the origin, they are grouped into kingdoms of vegetable, animal, mineral, nosode, sarcode, imponderabilia etc;
The use of plants forms the basis of traditional system of medicine all over the world.3There are evidences that plant based medicine goes back at least 100,000 years and probably even longer. It has been estimated that 2.5 to 7.5 lakhs species of higher plants exist on earth, some of these have not yet been botanically described. Although there is no way to determine accurately how many of these species have been used in traditional medicine, a reasonable estimate would be about 10% or from 25, 000 to 75,000 species. 5 However, perhaps only about 1% of these are acknowledged through scientific studies to have real therapeutic value when used by humans. All the plants or the plant products used in medicinal preparations are grouped into one category, which is called the Vegetable Kingdom. 5
The Vegetable Kingdom, offers us many varieties of medicinal substances, some are of great practical utility, and others have a limited sphere of usefulness. The medicines of this group owe their effects to the juices, which they contain, or to certain properties, which reside in the roots, flowers or seeds. The medicinal qualities of a plant may be obtained from various parts of it, and these qualities may vary from part to part. So while conducting the proving of a vegetable drug, one should be certain of the part of the plant used, and in publishing the proving, it should be clearly mentioned whether the whole plant is used or a single part of it. If a single part is used it should be accurately stated as to which part- the root, the flowers, the seeds etc. is used for preparation of the raw drug. 5
In the vegetable kingdom itself, the medicines are grouped into many according to the botanical classification of the plants from which they are derived. The medicine under discussion, Ceasalpinia sappan , comes under the family, Caesalpiniaceae under ordor leguminosae.
Is of 6-9m in height, the thickness is within the palm. It is with an ash-grey bark, (which is) yellowish brown inside, with quite hard, somewhat red wood, (turning) red with age; A shrub or small tree found in south India,West Bengal, Orissa and Madhya Pradesh; Ceylon, Burma andMalaya. It is usually cultivated as a hedge plant. The orange-red heartwood finds use in the dyeing of cotton, silk and wool fabrics.
STEM : Stem prickly,15-25cm.diameter.;with branches hanging down towards the sides, whitish inside, with short and curved spines running in between;
ROOT : the root is fibrous, from white to reddish, odourless; with saffron bark, covered with a black skin.
LEAVES : Leaves 20-38 cm; long; pinnae 8-12 pairs, 10-15 cm long subsessile, with small prickles at the base.Leaflets 10-18 pairs , 1.3-2 by 1 cm.,subsessile, close,oblong, rounded at the apex ,attached at the lowest corner,very inequilateral (the upper side much the largest ) glabrous above,more or less puberulous beneath.
The leaves have pleasing smell, the taste however slightly sharp and bitter. At sun-set, they shut in themselves and draw together with the inner sides like the leaves of Balam-pulli,
Flowers, without smell, yellow, burst forth many in racemes at the tips of defoliated shoots, consisting of ten, almost round, slender leaves, of which the five outer ones are a little cuspidate and light green; one of the middle ones being small, with rose coloured vein-lets thrown across, by the side of which is a green, oblong leaf, surrounding the whole flower. From the flowers there come out ten knotted, from yellow to green stamens, provided with black, semicircular apices, curved inwards, so also with a common smooth base, white with down, containing the rudiment of the fruit. Similar, compressed, large pods, adhering to strong petioles, are four transverse thumbs long and almost two thumbs (fingers) broad, with a thicker cuspidate back, the venter a little curved inwards, ripe and dried ones are with hard, horny and shining dark rind, covered inside with cartilage, which when they are younger, is transparent, then wraps and separates the oblong, slightly smooth seeds, (which are) from ash-grey to dark, adhering to the back of the pods transversely by means of tongue-like structures.
Flowers in panicles,which are terminal and in the axils of the upper leaves,30-40 cm long; pedicels 1.3-1.5 cm. long; bracts lanceolate, 8 mm. Long, caducous . Calyx 11mm, long ,leathery ,glabrous.Corolla 2 cm across; petals orbicular , subequal,yellow,the upper with a red spot at the base .Stamens declinate ,waxy white ; filaments densely woolly at the base . Ovary gray velvety.Pods 7.5-10 by 3.8-5 cm., woody , obliquely oblong,subcompressed,polished,indehiscent,with hard recurved short beak at the upper angle of the obtuse apex.
Being fond of sandy soil, it is commonly grown throughout the whole of Malabar, because of its decoration and use. It grows spontaneously (freely) in Travancoor. in the provinces of Goendre and Elle de Soroan and other mountainous places. Flowers from April up to September. Fruits are plucked by the end of the year. Bears fruits when three years old; extends its life to hundred years during winch it is never defoliated.
Under a microscope, a transverse section reveals ray Composed of 1 – 2 rows of slender and long cells; the area between rays filled with fiber cells, and large and oblong
Vessels scattered there; solitary crystals of calcium oxalate in Parenchymatous cells of the innermost of xylem.
PREPARATION OF MOTHER TINCTURE AND STANDARDISATION
Preparation of Mother Tincture – Class IV method.
1. Principle: The mother tincture is prepared by adding five parts by weight of strong alcohol to one part by weight of powdered drug.
Ingredients : drug substance and strong alcohol.
Appliances : chopping board and knife, mortar and pestle, horn spatula, linen cloth, beakers, glass bottles, glass funnel with stand, filter paper, glass rod, balance with weight box, pan, paper, gum etc;
3. Procedure: the dried vegetable substance was pulverized into a fine powder. The powdered drug was weighed and taken in a glass jar. Five times its weight of alcohol was added to it and mixed with the powder. After thorough mixing, the whole mass was kept in a glass-stopped bottle in a cool dark place for 15 days. The mixture was shaken nicely two times a day. After this period the clear tincture was decanted, the residual substance was strained by a new linen cloth, and added to the previously decanted tincture. It was again filtered by a filter paper, and stored in a glass- stopper phial.
QUALITATIVE CHEMICAL EXAMINATIONS
The extracts obtained above were subjected to qualitative tests for the identification of various plant constituents.
1. Detection of Alkaloids : stirred a small portion of the solvent free from chloroform, alcoholic and water extracts with a few drops of dilute hydrochloric acid and filtered. The filtrate was tested with Meyer’s reagent. Meyer’s test - -ve.
2. detection of Carbohydrates :
Dissolved a small quantity of the alcoholic and aqueous extracts separately in 4 ml of distilled water and filtered. The filtrate was tested with:
a. Mollisch’ reagent ( carbohydrate) – + ve.
b. Benedict’s test ( reducing sugar) – +ve.
3. Detection of protein and free Amino acids :
A small quantity of the alcoholic and aqueous extracts were separately dissolved in water and tested with :
a. Millon’s reagent – +ve
b. Biuret reagent – +ve
c. Ninhydrin reagent – +ve
THIN LAYER CHROMATOGRAPHY OF MOTHER TINCTURE (TLC).
The mother tincture was subjected to chromatographic separation by thin layer chromatography
Solvent System : Chloroform : Methanol :Acetic acid in 90:10:1 ratio.
Adsorbent – Pre coated silica Gel Plate
Visualisation by using spray reagent – 10% Sulphuric Acid in Chloroform : Methanol :Acetic acid in 90:10:1 ratio, four chrominant spots were observed with Rf values.
a) 0.93 b) 0.81 c) 0.66 d) 0.54
PRE-TRIAL MEDICAL EXAMINATION OF THE PROVER
As it is nearly impossible nowadays to find perfectly healthy provers, a format is designed to minimize recording of any pre-existing pathological symptoms. This is known as pre-medical examination proforma////// (Appendix-III). The details of physical and clinical examination along with constitutional, both mental/ emotional and physical traits were recorded in this form. Along with this, routine laboratory investigations were also done, Lab investigation Report/////// (Appendix-IV) to confirm the fitness of the prover.
POST- TRIAL MEDICAL EXAMINATION OF THE PROVER
After the completion of the experiment, all the physical and mental symptoms are again recorded. Along with this, similar lab investigations as carried out at the time of the pre-medical examination are also done. This is known as post-trial medical examination proforma ////(Appendix-III ).
DATA COMPILATION, INTERPRETATION AND FORMATION OF MATERIA MEDICA OF
When the proving trials conclude, all daily records of the provers are collected, and all symptoms, which represent deviations from the prover’s normal, listed. Any variations in pre and post proving findings (by comparing pre trial and post trial medical examination report forms) were also recorded. The symptoms generated by the placebo subjects (controls) are deleted from the records, all the remaining symptoms collected and Materia Medica is formed. While comparing the data, due care was exercised to retain the expression used by the provers “ipsissima verba” as far as possible. Those signs and symptoms, which were distinctly experienced by the prover(s) who were administered the drug, are arranged in a schematic manner (according to Boericke’s Materia Medica).
Statistical methodology will be utilized during clinical verification in 30 patients ( both male and female and of different age groups), attending the OPD and IPD of Govt: Homoeopathic Medical College, Calicut.
Vernacular name : Sappannam
Family : Caesalpiniaceae
Source : Stem -Heartwood
Habitat: Found in South India , West Bengal, Ceylon, Burma, and malaya . Commonly grown throughout the whole Malabar ,because of its decoration and use. It grows spontaneously (freely) in Travancore , in Kundara,north and south of Quilon
Preparation: Tincture from dried powdered heartywood –stem according to Class 1V method.
Sphere of action: It has prominent action on the gastro intestinal system, eye and head. Other important sites are the nose, throat, urinary system, locomotor system, and respiratory system.
Side affinity: Predominantly Left sided.
The decoction of wood is considered a powerful emmenagogue.It is used as such in Indo China .
Given internally as a decoction the wood is useful in some forms of skin diseases, lichen especially.
In China , the wood is used as a vulnerary for wounds, haemorrhages , and disturbance of menstrual functions. It is also considered astringent and sedative.
A decoction of wood is said to be very useful in curing dysentery and diarrhoea
Sappan wood is astringent and is administered as a decoction (1 in 20) in doses of 0 5-20 fluid oz.
Ayurvedic uses. The wood is bitter , dry sour ,cooling ;cures “vata”, biliousness, fevers,delirium, ulcers, strangury, urinary concretions, mental disorder; cures boils.///104
Blood complaints; improves the complexion
Uses in Yunani System of Medicine. The wood is bitter; stops bleeding from the chest and lungs; heals wounds, ulcers; improves the complexion; useful in rheumatism.
OBSERVATION & DISCUSSION
Proving was done in the age group 18-45 years. The majority of provers (15) come with in the age group of 21- 35 years (75%). Proving was conducted in both sexes. Male to female ratio is 11:9. Proving was done on 20 provers of which 30 % (6 provers) was placebo. Symptoms obtained with placebo were deleted from the total symptomatology, to get the correct picture of the drug.
Proving was done on the students, P.G.students and teaching staff of Govt: Homoeopathic Medical College,Calicut. Of the 20 provers, 7 are students, 11 are P.G. students and 2 are tutors. As the proving was conducted among the doctors and medical students, the best result was obtained, since the physician is the best prover. So the observation and documentation of symptoms was most reliable.
A small number of provers did not produce any symptoms at all during proving, some provers produced only mild symptoms, and while certain others produced very severe symptoms, even though all provers took the drug in the same potency, dosage and repetition.
Initially the dosage for intake of tincture was 5 drops four times daily. Since this did not produce any significant changes even after one week in majority of provers, the dosage was increased. In 30 C the initial dosage was 4 pills 4 times daily, to which some provers didn’t produce any response. So the dosage was increased to 4 pills 2 hourly. In those provers who produced symptoms according to the initial dosage of 4 pills 4 times daily, no change was brought in the dosage later.
The sphere of action of the drug was found to be different for different potencies. Certain symptoms were obtained commonly, in Q and 30 C potencies. These symptoms are more significant than those obtained either with Q or 30 C potency.
The intake of the drug was stopped as soon as distressing symptoms developed. In almost all provers, the intensity of symptoms decreased, followed by cessation of symptoms, as soon as the drug intake was stopped.
According to the latest proving protocol, proving was carried out only in the functional level. Proving was not extended to the toxicological or pathological level. Pre- trial laboratory investigations were conducted to assess the state of health of the provers. Only the healthy persons were selected for the proving programme. Post – trial laboratory investigations were also carried out, which did not reveal any significant changes in the biological values , since the proving was done only on the functional level.
Proving was conducted as a Randomised Controlled Trial (RCT). This eliminates bias, and helps to utilize the latest statistical methods in this study. The double blind, cross- over method used for this trial, helped to minimize the errors and to make the experiment most reliable.
Mental symptoms are produced during the proving of mother tincture. Symptoms obtained during proving of mother tincture were found to be of greater intensity and duration, when compared to those obtained with 30 C.
The modalities of symptoms occurring in three or more parts of the body, are considered for forming a general modality. Peculiar sensations relating to different parts of the body are retained in the language of the prover.
The most prominent time of aggravation was found to be in the morning, even though certain symptoms were aggravated in the evening and evening also. Specific modalities wherever observed were retained as such, in the symptomatology.
Almost all the provers had aggravation of abdominal complaints before food.
??????????????????? The miasmatic background of the drug is predominantly psoric. This was determined after analyzing the general modalities and characteristic features of the drug.
Most of the provers had increased appetite after the intake of the tincture. One prover had hypotension after intake of tincture ,this was verified several time on this prover
Relationship of this drug can be determined after repeated clinical verification.
The 30 cases selected for the study, had the same symptomatology as obtained in the drug pathogenesis.
Of the 30 cases, 17 (57%) were male and 13 (43%) were female. Out of 30 cases studied, 24 patients (80%) were relieved of their complaints. The remaining 6 patients (20%) did not show any improvement. For these patients, suitable similar acute medicines were given.
Only acute cases were selected for the study, since follow up time for chronic cases was insufficient. The symptomatology also points to the use of this drug in chronic conditions. So, clinical verification should also be done in chronic conditions to establish the complete therapeutic efficacy of this drug.
The study was conducted to elicit the proving of Caesalpinia sappan in Hahnemannian method, and to introduce this new medicine In Homoeopathy, it has great potential in the treatment of vertigo. It can also be used in the treatment of headache, dysuria, eye pain, loss of appetite and all gone feeling in abdomen
The present study included the preparation, proving and clinical verification. The mother tincture and 30 C were prepared under the guidance of Dr: K.S.Gopi, HOD, Dept of Pharmacy, Govt: Homoeopathic Medical College, Calicut. All the provers were given adequate training and guidance, carry out the proving and refrain from taking anything which would antidote the drug effect. This study was carried out over a period of one year as a part of the partial fulfillment of the rules and regulations for the M.D. (Hom) Materia Medica. The proving programme was carried out under the guidance and supervision of Dr: A.Esmail Sait, my guide who is the Principal (Rtd) of Govt: Homoeopathic Medical College, Calicut.
Proving new remedies has been a joy and a wonderful learning experience formyself . It is my hope that this work will stimulate theprofession to new and better provings so that together we may all benefitfrom this wonderful homoeopathic process.
Since the venture involves the proving and introduction of a new drug into Homoeopathy, this work needs further study and repeated clinical verification to establish itself in the Homoeopathic therapeutic field. I strongly believe that further clinical verification will enable this medicine to be of much use in Homoeopathy. I hope this will provide necessary initiative and impetus to further scientific research in Homoeopathy.
All rights reserved. (C) Dr.Muhammed Muneer. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including photocopy, recording or any information storage and retrieval system, without permission in writing from author.
Dr Mohamed Muneer MD(Hom)
Email : firstname.lastname@example.org
Mob : +91-9447185653
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