Clinical Cases

Chronic Hepatitis B Virus Infection: A Case Study

Muhammad Afzal
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Dr. Muhammad Afzal Sandhu shares a cured case of Hepatitis B.

Hepatitis B is a potentially serious form of liver inflammation due to infection by the Hepatitis B virus (HBV) and is one of the most common chronic infectious diseases worldwide. A case of HBV infection in a 50 years old female enrolled for homeopathic treatment is reported here. This case shows the usefulness of homeopathic medicines in giving not only symptomatic relief to the patient but also improving the pathological findings.

INTRODUCTION

Chronic hepatitis B (CHB) is defined as persistence of HBsAg in the circulation for more than 6 months1. At the beginning of the third millennium, Hepatitis B virus (HBV) remains a major public health problem globally; more than two billion people have been infected worldwide, and of these, 350-400 million suffer from chronic infection2, 3. HBV infection can induce a wide spectrum of clinical features, ranging from an inactive carrier state to fulminate hepatitis, cirrhosis, or hepatocellular carcinoma4.

Most patients with chronic Hepatitis B are clinically asymptomatic. Some may have nonspecific symptoms such as fatigue.  In most instances, significant clinical symptoms will develop only if liver disease progresses to decompensated cirrhosis. In addition, extrahepatic manifestations may cause symptoms. Accordingly, physical examination will be normal in most instances. In advanced liver disease there may be stigmata of chronic liver disease such as splenomegaly, spider angiomata, Caput medusae, palmar erythema, testicular atrophy, gynecomastia, etc. In patients with decompensated cirrhosis, jaundice, ascites, peripheral edema, and encephalopathy may be present5.

Hepatitis B is diagnosed by detecting one of the viral antigens called hepatitis B surface antigen (HBsAg) in the blood. Later in the acute disease, HBsAg may no longer be present, in which case a test for antibodies to a different antigen hepatitis B core antigen is used. If HBsAg can be detected in the blood for longer than six months, chronic hepatitis B is diagnosed6.

HBV and HDV were transmitted frequently by blood transfusion. Vertical transmission and sexual exposure have become the most frequent routes of HBV infection. Medical procedures still represent a potential source for HBV  transmissions and  thus strict and  careful  application of  standard hygienic precautions  for  all medical  interventions are absolutely mandatory not only in endemic areas but also in Western countries. This holds true in particular for immunocompromised individuals who are highly susceptible to HBV infection as HBV is characterized by a very high infectivity7.

An increasing number of patients are treated with methods of complementary and alternative medicine (CAM)8. Homeopathy is one of the most widespread and controversial therapies of CAM9 offering a ‘natural’ and effective alternative to conventional medicine, which is overly-dependent on the synthetic remedies of multinational ‘big pharma’10. In spite of widespread acceptance of the merits of CAM within the general public and amongst many medical practitioners, these more controversial treatments have faced sustained opposition from those who advocate an evidence-based approach. Homeopathy, in particular, has been the target of sustained criticism11-15.

The homoeopathic approach is “like should be cured with  like”.  Although homeopathy seems scientifically implausible, three meta-analyses of controlled trials have found an effect greater than placebo in different diseases16-18. Numerous early attempts have been made to prove the efficacy of ultra-highly diluted homeopathic remedies, but most have not been accepted due to some lacunae in experimental design or for methodological shortcomings, or for some other flaws in the reports19-21.  However, Khuda-Bukhsh et al.22-25 proposed a gene-regulatory hypothesis to explain the possible molecular mechanism of action of potentized homeopathic drugs with much circumstantial evidence to support their claim; this also needs to be further validated.

CASE PRESENTATION

Mrs. S. S. age 50 years, was diagnosed as Hepatitis B +ve in 14 may 2012 by ELISA.  On 16 March 2013 she was re-investigated for the detection of HBV-DNA by PCR, and this time it detected  HBV DNA. On December 24, 2012, she was consulted for homeopathic treatment of HBV infection.

 

Presenting Complaints

  • Pulsating headache of vertex region from the age of puberty, headache aggravated from cold wind, combing hair and during menses, and improved by wrapping up head with a cloth. (for 37 years)
  • Pain epigastric region with sensation of fullness which aggravates after eating. (5 months ago)
  • Pain right upper quadrant
  • Aching pain in chest with difficult breathing (5 month ago)
  • Abdominal pain aggravated after eating followed by loose stool. (5 months ago)
  • Pain cervical region with morning stiffness.
  • Patient experienced heat flushes in body on and off with heat in palm and soles, and she must uncover them even in winter. (for 2 years)
  • Patient was restless and physically weak.
  • Generally all symptoms worse by late night-watching or loss of sleep.

 

History of presenting illness

Patient was alright 37 years ago when she then experienced a headache during  puberty. Fifteen years ago she developed a feverish condition and consulted for a medical opinion. Laboratory tests were performed and HBs Ag test was positive. She had climacteric for 2 years. Five months ago she developed chest pain with difficult breathing, abdominal pain with loose stools and was admitted to a  hospital. She was diagnosed with Active HBV with an ALT about 57 u/l.

Past History

Personal History

  • H/o Malaria fever

Family History

  • H/o Hepatitis B, Uterine Fibroid and Heart disease in Mother
  • H/o Heart attack in grandfather/Maternal side.

 

PHYSICAL GENERALS

Appetite     : Diminished

Thirst         : Excessive for cold water

Desires        : Spicy food, sweets, cold drinks and foods, ice cream

Bowel Habits       : Urging for stool eating after

Urination    : Frequent Urging

Perspiration        : Profuse

Sleep     : Un-refreshing

Thermal reaction  : Hot patient

 

PHYSICAL EXAMINATION

  • Red discoloration of palms and nose
  • Goiter
  • Hypertension 170/100
  • Tachycardia

LABORATORY INVESTIGATIONS

  • HBs Ag by ELISA Method
  • HBV DNA by PCR
  • ALT

LABORATORY REPORTS AT ENTRY

  • HBs Ag by ELISA Method : Reactive
  • HBV DNA by PCR : Detected
  • ALT : 57 u/l

 

ANALYSIS AND EVALUATION OF SYMPTOMS

MENTALS:

Irritability

Anger at trifles

PARTICULARS:

PULSATING, throbbing Headache of Vertex

HEADACHE ameliorates by wrapping up head

HEADACHE from cold air

FULLNESS, sensation of stomach, aggravation eating after

PAIN stomach, eating agg

DISCOLORATION redness of nose

PAIN aching, Chest

PAIN, Liver region

LIVER chronic infection, hepatitis
PAIN Abdomen, aggravation after eating
URGING for stool  desire eating after
PAIN cervical region

STIFFNESS cervical region
HEAT foot sole uncovers them
DISCOLORATION redness palm
GOITRE, External Throat

PHYSICAL GENERALS:

SLEEP loss of, ailments from,

WEAKNESS, enervation, exhaustion, prostration, infirmity in general
RESTLESSNESS physically
HEAT flushes of on and off

DESIRE for sweets

DESIRE for cold water

DESIRE for ice-cream

DESIRE for spices, condiments, piquant, highly seasoned food

HYPERTENSION

Methodology Followed for Selection of Medicine

The medicines were narrowed down by repertorizing all the symptoms, identifying related rubrics with the help of The Complete Repertory and Murphy’s Medical Repertory using the Homeopathic Software Cara Professional. The remedies were chosen based on maximum rubrics and scores using generalities and characteristic particulars of the patient.

RESULTS

Treatment went on for about 3 months. Treatment started on 24-12-2012 with a single dose of Sulphur 200 followed by a single dose of Phosphorus 200. Nux vomica 200, Belladonna 30 and Merc sol 200 needed as complementary remedies.

During the span of treatment the patient was greatly relieved of all symptoms, however mild chest pain and abdominal pain were often experienced. For unspecified chest pain she was referred to a cardiologist. There were no findings indicated a cardiac anomaly. Treatment follow ups showed good recovery of signs and symptoms and laboratory tests improved (which included Non-Detection of HBV RNA and normal range of ALT.)

DISCUSSIONS and CONCLUSIONS

Treatment started from with a single dose of Sulphur 200, which was followed by a dose of Phosphorus 200. It seems that remedies act well if treatment begins with Sulfur in chronic disease, probably due to its anti-psoric properties (as psora is often the underlying cause of chronic diseases). Phosphorus was selected as a constitutional remedy on general characteristics and behavior of the patient and a particular affinity to the gastrointestinal tract and Liver.

The patient responded well to treatment and showed signs of improvement. Her headache, cervical pain and epigastric discomfort was markedly reduced. Her blood pressure was comfortably maintained. She stopped oral hypotensive drugs. Nux vom effectively reduced the abdominal pain and frequent urging for stool. An attack of throbbing headache was ameliorated by a few doses of Belladonna 30. In the last of treatment phase there appeared vesicular eruptions in the oral cavity with over salivation which was relieved by a dose of Merc sol 200. The PCR report for detection of HBV-DNA showed Non-Detection on March 16, 2013. The patient was re-tested for detection of HBV-DNA on December 30. 2013. The tests indicated Non-Detection of HBV-DNA. The usefulness of Phosphorus and Sulphur with associated remedies including Nux-v, Belladonna and Merc sol in the treatment of Hepatitis and associated symptoms mentioned in the literature of homeopathy has been verified and confirmed in the present case. Clinically she has recovered from hepatitis B virus infection at present. The patient may need to be followed up for a longer period to assess any change in the symptomatology and laboratory findings.  (See laboratory reports below).

About the author

Muhammad Afzal

Muhammad Afzal

Dr. Muhammad Afzal Sandhu received his BHMS from Islamia University Bahawalpur and a DHMS from Anwarul Islam Homeopathic Medical College Kasur. He’s been in homeopathic practice for fourteen years. He is also trained in microbiology (Univ of Lahore- Pakistan) and advanced acupuncture (Beijing China). He’s worked five years teaching anatomy, physiology, microbiology and materia medica. He is currently working with the Fauji Foundation- Lahore, as a homeopathic medical officer.

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12 Comments

  • Good case taking presentation and selection of drugs.After all nice result even in obstinate disease.congratulation.

  • Good case taking presentation and selection of drugs.After all nice result even in obstinate disease.congratulation.Follow up the case.

  • Sulphur and phosporous with complimentry medicines have helped to cure this case. Dr.Mohamed afzal may indicate whether this case is completely cured whether this case is followed thereafter.

  • Thank You for the brilliant clinical case. What about HBsAg and the other antigens of HBV (HBeAg, HBeAb) after the treatment?
    Best regards

  • The case presented in chronological order which shows an in depth knowledge and confidence of the author of this article and efficacy of Homoeopathic treatment also.We expect further such cases from him. Wish him all success.

  • Pl tell me sir, I am hepatitis b positive since 2.5years .,what is treatment in homoeopathy. Pl give details.to be come nigative hbs ag. Give treatments, what’s fee for treatment. Pksaxena 262001 pilibhit up