The purpose of this paper is to point out the miasmatic nature of a condition known as endometriosis and to suggest a possible approach in the homeopathic treatment of endometriosis. It is not intended that this paper present a cured case of endometriosis.

The nature, aetiology and pathophysiology of endometriosis will be touched upon and a homeopathic interpretation based on miasmatic theory will be offered. A case that responded dramatically to miasmatic prescribing will be presented.

What is endometriosis?

Endometriosis is the growth of cells similar to those that form the inside of the uterus (endometrial cells), but in a location outside of the uterus. Endometrial cells are the same cells that are shed each month during menstruation. The cells of endometriosis attach themselves to tissue outside the uterus and are called endometriosis implants. The implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder, although less commonly than other locations in the pelvis. Rarely, endometriosis implants can occur outside the pelvis, on the liver, in old surgery scars, and even in or around the lung or brain. Endometrial implants are generally benign (not cancerous).[1]

Characteristics of Endometriosis

The following are some of the commonest characteristic symptoms of endometriosis. This list is compiled from clinical experience of patients suffering from endometriosis.

·       Aggravation of many symptoms in the patients before, during, or after menses.

·       Periodicity of 4 weeks. The cycles are frequently shortened to 3 weeks, showing a poor development of the corpus luteal phase of the menstrual cycle and a weak progesterone phase.

·       Bleeding, per vaginal discharge, brown, bloody, black, copious, watery. The color and nature will vary with the phase in the cycle. The watery discharge, gushing and slightly bloody can occur during ovulation.

·       Insidious onset, usually in the mid 30’s, a close association with infertility or after a long period of not being pregnant.

·       Worsens with time and regresses after menopause; regresses during pregnancy and lactation because endometrial tissues regress with the depletion in hormones during menopause and the loss of the cyclical rhythm during pregnancy under hormonal influence.

·       Pain may be severe depending on the staging and other factors but coming at 4 week intervals, pain may be felt in the abdomen, supra pubic area, back, down the thighs (referred pain), rectum, etc. depending on the location of the cysts. Dyschaesia, i.e. pain when passing stools especially before during and after menses and dyspareunia, i.e. pain during intercourse may be present. These symptoms may be due to the endometriotic lesions in the pouch of Douglas.

·       Associated problems include emotional upsets, usually suppressed emotions, digestive problems from dyspepsia to colitis, the mildest being irritable bowel syndrome but may be severe mucous colitis, and adhesion colic.

Consequences

·       Infertility.

·       Debilitated state of patient who may not be able to assume daily activities usually two weeks in a month, every month.

·       A constant cycle of pain, recovery, a short period of feeling relatively well then a repeat. Body ache and tiredness as well as Inability to cope are frequently associated with this condition when severe.

·       Pathological changes are blood cysts in the ovaries, fallopian tubes, adherent to intestines or within the uterus resulting in adhesions, blocked tubes, and its consequences like hydrosalpinx.

·       Occasional malignant change.

·       Emotional upsets and relationship problems

There are many theories as to why endometriosis occurs. The one that I subscribe to is that there is a genetic predisposition to endometriosis.  I also believe it is not a disease of the reproductive organs, but part of a larger disease that involves the immune system.

Genetic studies have shown that endometriosis may have a genetic basis, just like diabetes and hypertension. Studies on a species of monkey that spontaneously develops endometriosis are being done to demonstrate this [2]

That the immune system is affected in endometriosis was researched in a survey where the following conclusion was arrived at :

"Hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergies and asthma are all significantly more common in women with endometriosis than in women in the general USA population."[3] 

Most of the diseases mentioned here are related to a defective immune system and to auto antibodies. It is possible that all of it is related to a defective immune system, but we do not yet have full knowledge of these conditions.  While it is not stated that the hypothyroidism mentioned here is autoimmune, there is autoimmune thyroiditis which is also known as Hashimoto's Thyroiditis, which leads to hypothyroidism

What seems to be happening in endometriosis is that cells that are normally found only in the endometrium of the uterus implant in other places, where they respond to the ovarian hormones in a cyclical manner and bleed when the hormone levels drop as in the normal menstrual cycle.

Two main theories exist for the pathogenesis of endometriosis. One theory is that endometrial tissue is spread by retrograde menstruation or by vascular and/or lymphatic spread. The second theory holds that the serosal epithelium of the peritoneum undergoes metaplastic differentiation into endometrium-like tissue.[4]

Endometriosis is a chronic disease that has established itself by the time a diagnosis is made. While I have not been able to find any researcher who links endometriosis to pelvic infections, there is evidence that patients with endometriosis do have infected endometriotic cysts.

Schmidt et al found pathologic evidence of infection in 11 of 510 endometriotic cysts (2%). The patients had a mean age of 34.7 years and typically presented with fever and lower abdominal pain; about half had a history of pelvic inflammatory disease. Histologic examination revealed endometriotic cysts that contained a fibrino purulent exudate, micro-abscesses, and inflammatory cells other than neutrophils, such as plasma cells. All of the patients who had one or both fallopian tubes removed at the same operation had histologic evidence of acute and/or chronic salpingitis.[5]

A Miasmatic theory of Endometriosis

In Webster's dictionary, the term "miasm" is followed by these meanings:

"a vaporous exhalation (as of a marshy region or of a putrescent matter) formerly believed to contain a substance causing disease (as malaria)"

"a pervasive influence or atmosphere that tends to deplete or corrupt". Its Greek root is "miainein" which means "to defile". "to defile" means "to make something dirty or no longer pure" "to damage something holy or sacred".

According to Shahrdar:

"From Hahnemann's writings, it is evident that he also uses the word "miasm" simply to describe an infectious and contagious disease with a specific cause and pattern of growth which can appear in different forms of propagation such as sporadic, endemic or epidemic. In his view, a miasm may be acute or it can be chronic with ever progressing effects on the individual. Speaking in Hahnemann's language, it should be noted that what is now known as a miasm is actually a chronic miasm".[6]

Hence a chronic miasm is a disease that keeps progressing even when a prescription has been made that covers the presenting symptom - for according to Hahnemann, there is a hidden process that needs to be prescribed for and an unmasking of the original symptoms before a miasmatic prescription can take place.

I have made a graphic presentation of what I understand about Hahnemann's Chronic Disease theory. To learn more please visit the minutus.org library and study Dr Shahrdar's writings.

The terms ponos and pathos are from the writings of Hans Selye[7] and have been adapted by Shahrdar, hence I have placed them in brackets.

Ponos is the acute symptoms as a reaction to the pathogen.

Pathos is Latin for suffering and refers to secondary symptoms as the patient's body adjusts to a state of incomplete resolution after a pathogen.

Miasmatic remedy refers to the remedy who’s choice is based on the combined symptoms of many patients who are affected by a similar pathogen. (Shahrdar uses the term ‘genus epidemicus’.)

Dr. Shahrdar has proposed that the most important group of pathogens that can cause a chronic state are viruses. He has written Materia Virosum and Repertorium Virosum that discusses these theories in great lengths and shows how they can be applied to treat cases miasmatically.  I will show how it can be applied in the case we will be discussing shortly.[8]

When a person is infected by a pathogen, there is an acute illness (ponos) which is an acute disturbance caused by the pathogen. In acute diseases the infection is resolved and the patient returns to the normal optimal state. When this does not take place, the patient develops more suffering and the illness becomes chronic (pathos). Chronic illness is an adaptive state where the health is compromised and the body develops ways to adapt to the compromise in health in order to survive. An example of this is when a splinter is in the flesh and the body deals with the splinter at first by suppuration. This is the ponos reaction and then when the splinter still remains, the body acts by depositing fibrous tissue and sending white blood cells to continue attacking the splinter and the person develops a foreign body granuloma. This secondary reaction is the pathos.

In the state of Pathos, the disease progresses similarly to what we frequently see in chronic diseases like rheumatoid arthritis, systemic lupus or diabetes. It will keep getting more complex because of the presence of the unhealed chronic miasmatic state that has been hidden under the pathos. A homeopathic remedy that can heal this person has to address the original unmasked hidden state - that is, the original illness. Hence it has to be a miasmatic remedy that is similar to the hidden state and not to the general adaptive symptoms of the patient. To put it in another way, what we see is the secondary adaptive symptoms, the secondary pathological changes and not the hidden disease process that causes these reactions. In order to cure the person, we have to prescribe a remedy similar to the active hidden process.  We need to unmask the hidden miasm.

A hidden state here means that the vital force did not return to normal and remains off balance.
Obviously when something is off balance, the body has to make adjustments to deal with the lack of balance.

Example:
You hurt your foot by walking on a piece of glass and there is a cut on the sole. Now you walk bearing your weight on the other foot that is healthy. When a homeopath sees you, he sees the limp but he does not see the cut and injured sole, which remains hidden, unless you tell him about the injury and show it to him. If not, it is hidden but still active. The limp is to compensate for the injured foot and the pain that comes from walking on the injury.  If this situation remains for say 10 days, then more things start to happen. Because the uninjured foot has had to bear more weight, it is now being strained and, let us say there is an underlying weakness of the hip joint on this side, and now there is a limp, and pain in the hip on the uninjured side.
What needs to be treated is still the cut on the sole because apparently there is still pain causing the whole compensatory way of walking. All of the compensation is due to the vital force acting in total, but the primary state and the whole cause is still the injured foot.

One might then say, since I added that the hip has an inherent weakness ,that there is actually another state at work here and we would be right. But, if we tried to deal with this part first, the cure would not work because, the injured foot was what started to make the hip painful and it is still active.

SUMITA’s CASE: Endometriosis with Primary Infertility

Sumita is a patient of a homeopath in India and I am in Malaysia. I agreed to help him treat Sumita as a consultant and he is the homeopath who took this history. I was consulted because of primary infertility due to endometriosis, which was discovered after she was married. She did not get pregnant in the two and a half years of marriage and had undergone both homeopathic as well as allopathic management before I was consulted. She had been diagnosed to be suffering from Endometriosis by ultrasound as well as by Laparoscopy. This is important since a diagnosis of endometriosis by clinical picture or ultrasound alone is not conclusive. Note also the ultrasounds were done intra vaginal which makes them more accurate.

This case was taken at the first interview. Unless indicated as allopathic, all the doctors mentioned refer to qualified homeopathic doctors (BHMS)

Age: 27 + Married for 2 and half years, No children.

Fair, Height 5 ft, Weight 46 kg, Medium build.

History:

Menstrual Cycle of 28 days, Last time flow for 1-2 days. Soreness in lower abdomen with both legs being painful. Occasional pain in both ovaries. Occasional Leucorrhoea (thick lumps).

Last menstrual period, 2nd June 2007.

History and Background:

1.   Had a history of severe injury to the head when 7 or 8 years old.

2.   Had a history of headache for last 10 - 12 years agg. by sunlight, Tension, Concentration, long journeys. Used to take painkillers (diclofenac 0.25 mg) to relieve the pain.

3.   Left sided. Pain after sitting for long time in front of Computer (Last 3-4 years).

4.   Homeopathic treatment commenced after marriage i.e. Feb 2005 to treat headache. Had B Coli infection during March 2005. After eight months of treatment, started having menstrual pain. Pain used to stay during the periods with fever. However headache reduced subsequently under a different homeopath.

5.   Menstrual Pain did not reduce after continued homeopathic treatment till June 2006. i.e one and half years  of homeopathic treatment.

The then homeopath sadly passed away in July 2006. He had given the following medicines in chronological order. Arnica 1M 2 doses;, Cannabis Sataiva 1M 2 doses (For B coli infection); Tub 1M 2 doses; Bell 2C, Syphillinum 10M - 1 dose; Rhus tox 1m 2 doses; Kali Bich 1M 2 doses; Ant Crud 1M, 3 doses;  Sulph 30 1 dose; Puls 1M 2 doses; Calc Phos 1M 8 doses; Sabina 30; Colocynth 200; Bovista 200 3 doses. (Note the frequent change of remedies over one month).

6.   At the end of July 2006 the menstrual pain became very severe. Pain was felt particularly in the region of left ovary. USG done in July 2006 lead to diagnosed as Chocolate cyst on left ovary sized 3.7 x 3.2 cm. Uterus anteverted.

7.   A new doctor was consulted who gave Viburnum Opulus 6 to be taken twice daily. Next period menstrual pain was less but flow lasted for only one day. Patient bedridden with severe ovarian pain.

8.   Another doctor was consulted. He gave Lachesis 30 3-doses, repeated 30 3-doses after 10 days and then repeated 200c 2-doses after 14 days. First and second dose was very helpful but 200c caused an adverse reaction with severe pain in both ovaries. The doctor said the medicine has been overdosed.

9.   Was again referred to another doctor in August 2006. He gave Camphor 200 2-doses to neutralize Lachesis and gave Apis 200 three doses. Was better after Apis, then given Pulsatilla CM. Again pain started.

10. Ultrasound scan on September 2006 (2 months after first scan) showed that the cyst on left ovary had increased to 6 x 5.5 cm and the on the right ovary a new chocolate cyst was developed of size 3.2 cm. Uterus Bulky. Musculature,  Endometrium 6 mm Thickness.

11. Allopathic doctor immediately recommended diagnostic laparoscopy in September 2006. During Laparoscopy the endometrial cyst contents from the right ovary was aspired.

Report:

Dye Test: Spillage in both side, Endometriosis and adhesions were found,

Hysteroscopy showed Uterine Cavity & Cervical canal appeared normal,

Both Ostea Visulised.

      Bulky Uterus with endometriosis and adhesions.

12. Given an injection of GNRH 3.75 advised Super Ovulation.

13. Again Homeopathic treatment commenced from November 2006 under the same Doctor. Has given the following medicine in chronological order.

Bacillinium 10m 1 dose with Calc Phos 6x and Ashoka Q; Cimicifuga 1M with Bell Perenis Q and Oophorinum 30c, Calc Phos 200 cwith Bell Perenis Q with Ashoka Q, Bryonia 0/2 with Ustiliago Q.

      (a mixture of remedies and repeated over a short period of time)

14. Again undergone ultrasound examination on 23-04-2007. The following were found:

Uterus is anteverted, normal in shape, size and outline. Myometrial echo pattern is homogeneous, cavity is empty. Midline echo is normal. Endometrial thickness is 0.5cm. Cervical canal is normal.

Right adnexal region shows a partly solid and partly cystic space occupying lesion, measuring

5.4 x 6.3 cm.

Left adnexal region shows a cystic mass measuring 5. x 5.8 cm.

Both the space occupying lesions (SOL) are adherent to the uterus.

IMPRESSIONS

Bilateral Ovarian Cyst (Chocolate cyst)

Features of Pelvic endometriosis.

PRESENT COMPLAINT

·       Headache (much reduced by Homeopathic treatment)

·       Occasional Vertigo, Occasional nausea during morning

·       Developed yellowish blackish nails with spoon type shape

·       Nerve stimuli (kind of nerve shock) of mainly right leg during sleep. After this leg cannot be straightened for 1 minute. Then the affected leg became sore for 1-2 days. This has happened 5-7 times in last 2 years.

·       Both breasts sore. Worst before periods and better after periods.

·       Itching eruptions in elbow joint (front side) itching agg. by sweating.

·       Piles. Constipation.

·       Mild pain in ovarian region after urination and stool. Cannot control the urge to stool.  The entire stomach becomes stiff and movement and standing difficult until and unless stool passes.

Physical Generals

Warm Patient, Consolation amel., Sweating ++ under arms and face, Craving for cold food and cold water, Crave for Salty food, Craving for egg but cannot tolerate omelette. Appetite normal. Cold palms occasionally.

Mental Generals

Mild, easily weeps, Fear from shouting and quarrels, religious, good natured, family life comfortable, irritability before period, depressed (better after Puls 200)

Family History

Migraine of Mother, Diabetes of Maternal Uncle.

Past History

Vaccination, Typhoid (Detected in early stage), Injury to head, hand and collar bone.

.......................................................................................................................................................

Another ultrasound was done before she started treatment with me

Report: 6 July 2007

Uterus is antiverted, normal in shape, size and outline. Myometrial echo pattern is homogeneous Cavity is empty.  Midline echo is normal. Endometrial thickness is 0.4cm.

Cervical canal is normal.
A thick walled cystic SOL, measuring 2.9 x 5.2 cm another rounded thick walled cystic SOL measuring 3.4 x 4.2 cm. is seen in the Pouch of Douglas.

Both cystic SOL show low level internal echoes.

IMPRESSION

Bilateral ovarian cyst (Chocolate cyst?).

After a discussion with her husband I discovered that Sumita was very sensitive to homeopathic remedies and aggravated a lot after remedies were given repeatedly.

Since I know endometriosis has a miasmatic background, it was noted that any remedy chosen had to match not only the miasmatic background, but also aspects of her presenting symptoms, signs and modalities.

Endometriosis is a sycotic condition because of the nature of the disease, which involves the pelvic organs and sexual organs.  It has cysts and fibrosis and these are also sycotic.

Here is a bit about the general nature of the main miasms

General Nature of the Miasm (from JH Allen)

A - Psoric Miasm: Itching, burning, inflammation leading to congestion - philosopher, selfish, restless, weak, fears.

B - Sycotic Miasm: Over production, growths like warts, condylomata, fibrous tissue, attacks internal organs, pelvis, and sexual organs. (These are characteristics of endometriosis)

C - Syphilitic Miasm: Destructive, disorder everywhere, ulceration, fissures, deformities, ignorance, suicidal, depressed, memory diminished.

D - Tubercular Miasm: Changing symptomology, vague, weakness, shifting in location, depletion, dissatisfaction, lack of tolerance, careless, "problem child", cravings that are not good for them.

A quote from an article by Dr Ardavan Shahrdar on miasmatic analysis:

"1. Miasmatic analysis is the process of referring to Genus Epidemicus of infectious states to complete the image which is needed for the selection of the Simillimum.

2.  This type of analysis is actually based on the Hahnemannian definition of miasmatic prescription. In some schools of homeopathy, you may see different miasmatic categories instead of what is here called Genus Epidemicus. Here, the term miasm means infectious disease, as termed by Hahnemann.

3. By 'infectious diseases' I am not referring to 'infectious agents'. 'Infectious disease' is the dynamic state following the stress caused by" infectious agent". The infectious "state" can persist without the presence of "'infectious agent'.

I would like to point out that by Sycosis I mean sycosis according to what Hahnemann wrote in chronic diseases and not the sycosis that has been defined by various authors according to their own notions of sycosis.

Hahnemann refers to sycosis as the fig wart disease and we now know that it is venereal wart, which is condyloma acuminatum.

Here is another quote that may bring more clarity to the meaning of sycosis

"Now we clearly know that the figwart part of Sycosis is actually Condyloma acuminatum. HPV, the virus related to condyloma acuminatum, does not cause urethritis and gonorrhea in common terminology. The type of gonorrhea that Hahnemann linked to Sycosis is actually the urethritis caused by Herpes Simplex Virus type 2 (HSV-2) which can occur as co-infection with HPV. That's why Hahnemann states that figwarts are not always associated with gonorrhea."[9]

Hence the sycosis that is meant by Hahnemann, is actually an HPV infection that has been complicated by a Herpes Simplex type 2. This is merely a theory of Shahrdar that I chose to accept in analysing cases. Sumita's case is one of many that I have successfully treated by applying the same theory. I chose Sumita's case because the records were complete and I also had a history of her previous remedies, which I usually fail to get when patients come to see me from other homeopaths.

Shahrdar has compiled a materia virosa in which he has collected from various sources the pathology  produced by various viruses. Below you can see how Sumita's symptoms correspond to the HSV2 and the HPV viral states. I am not saying that she has these two infections, only the viral state which Hahnemann named miasm.  J.H. Allen in his book Chronic Miasms and Pseudopsora ,clearly stated that the sycotic miasm affected the pelvic organs as we see in cases of endometriosis in general and in Sumita's case in particular.

 Hahnemann differentiates sycotic Gonorrhoea from what he called the common Gonorrhoea. A careful reading of his description of the initial stages of Sycosis in his book Chronic Diseases will show that he distinguishes simple Gonorrhea from the more compelex Gonorrhoea of sycosis.[10]

"The gonorrhoea dependent on the figwart-miasma, as well as the above-mentioned excrescences (i.e., the whole sycosis), are cured most surely and most thoroughly through the internal use of Thuja,* which, in this case, is Homoeopathic, in a dose of a few pellets as large as poppy seeds, moistened with the dilution potentized to the decillionth degree, and when these have exhausted their action after fifteen, twenty, thirty, forty days, alternating with just as small a dose of nitric acid, diluted to the decillionth degree, which must be allowed to act as long a time, in order to remove the gonorrhoea and the excrescences; i.e., the whole sycosis. It is not necessary to use any external application, except in the most inveterate and difficult cases, when the larger figwarts may be moistened every day with the mild, pure juice pressed from the green leaves of Thuja, mixed with an equal quantity of alcohol." Chronic Diseases page 84

Below is a repertorization to search for viral states using repetorium virosum

This is a Repertorium Virosum analysis of Sumita's symptoms.

Note that the rubrics chosen are:

Female Leucorrhea

Female Itching

Buttock Pain shooting

Rectum constipation

Rectum hemorrhoid

The reason for the brevity and seemingly general symptoms are because of the way the materia virosa is recorded. It is all just clinical symptoms and very brief.

The other limitation of materia virosa is that it does not record secondary symptoms. For example there is no entry on dysmenorrhea or endometriosis. The only entry on endometrium is endometritis which is an acute state and not related to endometriosis,  though it would be related to fibroid uterus which is actually a culmination of chronic inflammation, which we later found Sumita also had.

The RV has many limitations

1. Few and brief symptoms

2. Most secondary symptoms are not in it, and have to be deduced.

In spite of these limitations, in the hands of a person who can translate secondary symptoms back to their primary symptoms the software is a great tool for deducing the viral state that is still active. Please note that viral state is another name for viral miasm, which can be said to be a subgroup of the original miasms of Hahnemann.

In this analysis the virus that has all the rubrics is HSV2.

HPV has only one rubric, but knowing the Human Papiloma virus's affinity to the pelvic mucous membrane as well as it being implicated in Hahnemann's original sycotic miasm, I am inclined to think that this is a miasm that at the moment, is not dormant but present.

Below are the materia virosa of the two viral states that I mentioned above.

Papilloma viruses/Human Papilloma Virus (HPV) Main Regions

Skin, Male organs, Female organs, Mind, Extremities, Larynx, Respiration.

Modalities: Aggravations: Night.

Mind: Sadness. Taciturnity. Loathing at life. Dullness. Anger. Irritability.

Crusty eruptions. Occipital pressing pain.

Eye: Conjunctivitis. Pressing pain.

Vision: Dim vision

Nose: Catarrh. Yellow discharge.

Mouth: Condyloma.

Throat: Mucous. Pain on swallowing.

External throat: Cervical lymphadenopathy.

Stomach: Increased appetite. Eructations.

Abdomen: Distention and rumbling. Cramping pains.

Rectum: Hemorrhoids. Burning pain after stool.

Prostate gland: Enlarged prostate.

Urethra: Burning pain during urination.

Larynx: Altered cry in children. Hoarseness.

Respiration: Distress. Stridor.

Female organs: Cervical cancer. Maculopapular eruptions. Warts.

Male organs: Maculopapular eruptions. Warts. Increased sexual desire.

Expectoration Increased.

Extremities: Warts. Painful plantar warts. Itching of lower limbs. Weakness of knee.

Back: Stiffness in cervical region.

Sleep: Sleeplessness. Falling asleep late.

Skin: Warts. Painful warts.

General: Weakness. Lack of vital heat. Burning pains. Stitching pains. Yellow discharges. Aggravation at

nights.

Antimiasmatic remedies THUJ, NIT-AC, CALC, LYC, Nat-s, Staph, Sabin, Sars.

Herpes Simplex Virus 2 (HSV-2)

Main Regions

Skin. Genital organs. Rectum. Extremities. Chest. Eye. Head. Mind. Urinary system.

Modalities: < Cold.

Mind: Irritability. Anger, Excitement, Dullness, Weakness of memory.

Vertigo

Head: Encephalitis. Meningitis aseptic. Headache pressing, stitching. Frontal headache. Occipital pressing headache. Headache aggravated by stooping. Crusty eruptions on head. Moist eruptions. Falling of hair. Heaviness.

Face: Herpetic eruptions. Heat.

Eye: Chemosis. Retinitis. Ophthalmitis. Chorioretinitis. Conjunctivitis pustular. Dendritic lesions of cornea. Keratitis. Retinal necrosis. Pain burning, pressing, stitching. Photophobia. Blepharitis.

Vision: Blindness. Blurred. Dim.

Ear: Pain stitching.

Nose: Catarrh. Coryza. Purulent discharge. Dryness inside nose. Internal sore pain. Scurfy nostrils.

Mouth: Gingivitis. Stomatitis. Ulceration. Ulceration of tongue.

Throat: Exudation. Pharyngitis. Tonsillitis. Ulceration. Stitching pain.

Esophagus: Dysphagia. Odynophagia.

External throat: Cervical lymphadenopathy.

Stomach: Diminished appetite. Increased appetite. Nausea. Vomiting. Eructations. Pain pressing.

Abdomen: Hepatitis. Distention. Rumbling. Cramping pain.

Inguinal region: Tender lymphadenopathy. Herpetic eruptions.

Rectum: Constipation. Diarrhea. Discharge. Necrosis. Pain burning, after stool. Proctitis. Tenesmus. Ulceration. Excoriation. Weakness of anal sphincter. Hemorrhoids. Hemorrhage. Itching.

Stool: Frequent.

Bladder: Enlarged bladder. Enuresis.

Urethra: Discharge gleety.

Urine: Dysuria. Frequency. Retention. Cloudy.

Larynx: Hoarseness of voice

Chest: Vesicular eruptions. Axillary lymphadenopathy. Substernal pain. Interstitial pneumonia. Pneumonitis. Irritation in trachea. Oppression. Stitching pain.

Cough: Dry. Short.

Female organs: Endometritis. Herpetic eruptions. Pustular eruptions. Vesicles. Salpingitis. Ulcers. Inflammation. Excoriation. Itching. Leukorrhea. Menorrhagia.

Male organs: Herpetic eruptions. Impotency. Prostatitis.

Extremities: Arthritis monoarticular. Edema of fingers. Herperic eruptions on thighs. Pustular eruptions on fingers. Vesicular eruptions fingers. Erythema of fingers. Tenderness of fingers. Shooting pains. Tingling. Herperic whitlow. Coldness and perspiration of feet and hands. Cracking in joints. Heaviness of lower limbs. Itching of lower limbs. Stitching pain in knees. Right side.

Back: Stiffness of cervical region. Anesthesia or hyperesthesia of lower back and sacral region.

Buttock: Herpertic eruptions. Shooting pain. Tingling.

Perineal region: Anesthesia. Hyperesthesia.

Sleep: Falling asleep late.

Dreams: Anxious.

Skin: Eruptions. Erythema multiforme. Herpetic eruptions. Tubercles. Boils. Ulcers. Itching.

Fever: Fever.

General: Anorexia. Hemorrhage. Hyperesthesia. Hypothermia. Lymphadenitis. Malaise. Myalgia. Myelitis transverse. Radiculopathy. Sepsis. Weight loss. Thrombocytopenia. Dryness of mucous membranes. Weakness. Emaciation. Ulceration. Excoriation. Stitching pains.

Antimiasmatic remedies: MERC, Nat-m, Petr, Nit-ac, Calc, Thuj.

From the above note the genus epidemicus (miasmatic) remedies for HPV are:

THUJ, NIT-AC, CALC, LYC, Nat-s, Staph, Sabin, Sars.

And the genus epidemicus ( miasmatic ) remedies for HSV2 are :

MERC, Nat-m, Petr, Nit-ac, Calc, Thuj.

Below is a repertorisation using Hompath Classic version 8.

Homepath Rubrics were taken for almost all of the symptoms she was having at that point. These are the rubrics that I chose. I chose them because they are the symptoms of the underlying miasm, which is active at that point in time. I included some general symptoms but ignored her “pain after stools” because it is a secondary symptom caused by adhesions (due to endometrial lesions in her peritoneal cavity), which means they are secondary symptoms and of no use in pointing to the underlying miasm. You will find some of these symptoms under materia virosum of HSV2, which means they belong to the Viral State of Herpes Type 2.

1. Rectum, haemorrhoids.

2. Head Pain, headache in general, sore bruised sensitive to pressure

3. Female genitalia, pain general 

4. Extremities, Cramps, leg calf -night

5. Vertigo

6. Breast sore before menses

7. Food and drinks, Salt desires

8. Extremities, Nails discoloration

Here is the repertorization

.

The top 5 remedies are Nitric Acid, Sulphur, Calc Lyc and Phos. The only remedy with all the rubrics is Nitric Acid. This is also the remedy present in Shahrdar's materia virosum list for both HSV2 and HPV.

The remedy that seemed to be the closest similimum for Sumita in both her total self as well as the viral state (miasm) that was present, is NITRIC ACID.

I had instructed Sumita to take Nitric Acid 200c in water. The reason being that I knew she was sensitive. Some may want to know why I did not use LM. I do use LM but in this case I wanted to use the 200c potency. Homeopathy as many of us know is not such an exact science of knowing exactly what and how to give a remedy and many of us will just make a decision and change the decision or not based on the results obtained.

Here is a report after the first 3 doses, actually a split liquid dose since a few drops of tincture was placed in 60 ml of water and the remedy given in three doses, shaking the bottle before each dose.

The medicine Acid Nitric 200c; was given one dose on; 9.07.2007 and another; two doses on 10. 07.2007. I am writing down the symptoms in chronological manner:

11.07.2007	- Slight pain in both ovaries, feeling very hot
12.07.2007	- Vertigo (a kind of crawling pain in the head), feeling very drowsy, had mild temperature 99 deg F
13.07.2007	- No fever - Vertigo or crawling pain agg morning, afternoon and night
14.07.2007.	- Constipation and Vertigo or crawling pain head.
15.07.2007-	- Hard stool followed by normal stool, again diarrhoea three times also vertigo or crawling pain in the head.
16.07.2007	- once semi solid stool, stomach rumbling, left hip portion feels stiff, feeling discomfort while breathing, slight discomfort in ovarian region while walking and breathing and sitting. She says that there is something moving along the nerves in the head. When stooping eyes get closed.
reported on 15 Jul 2007

After this report I asked her to wait before any further dosing, and here is the next report.

Note the ultrasound findings.

Medicine taken: Acid Nitric 200C on 9th and 10th July 2007

Aggravation for 10 to 12 days including leg pain, headache, fever, diarrhea

LMP: 26th July 2007

Flow after 26 days of last period (usually 28) (Last period 30.06.07)

Just before flow she had four stools. Stool was in adequate quantity, which aggravated the fissure and piles.

Heaviness of the lower abdomen before period and continued for first two days.

Slight pain in ovary during period. Normal flow.

Before period irritation, tension and weakness.

Before 4 to 5 days of period (21 and 22 July), there was both leg pain and arm pain (shoulder to finger tip)

Flow lasted for 2 days

On 4th and fifth day there was diarrhoea.

General Symptoms:

Breast soreness is always present but much less. Earlier aggravation was before period.

Heaviness of the head with headaches (slight), which seems to come from top and move downwards to forehead (last two days).

When getting up there is a slight sensation (Like air lock) in the right ovarian region.

When urinating urine feels as if it is flowing out of lower abdomen.

For last two days there is vomiting tendency, agg. on seeing food and smell of vegetable. (Now less)

Nails dotted/flattened still present.

Itching eruption in the front portion of both elbows had reduced but now more aggr. from water & sweat. Seems to spread in area.

Abdominal gas present.

Rectal fissure is not there but piles present (which comes out and moves in).

Now can control urge to stool, but slight discomfort present. (Lower abdomen becomes stiff –as if filled with gas on urge to stool.)

No cough and cold.

Sweat in underarms.

There is a slight soreness in the lower abdomen, which can be felt on breathing.

Ultra sound report ( Intra Vaginal Probe) Report done on 2.08.2007

Uterus is normal in size, cavities free.

Rt. side ovary- there is an organized cyst of 2.98 by 2.76 cm

Lt. side ovary -there is a cyst of 2.45 by 2.22 cm.

Pouch of Douglas is free

It was obvious that her endometriosis was on the retreat. The cysts were smaller and the lesions in the pouch of Douglas had disappeared.

She was given a repeat split dose of Nitric Acid 200c again on 13-15 August 2008 and she subsequently became amenorrheic and was tested to be pregnant.

Here is a tabular record of her progress:

Date of Med	Medicine	Main Events	my comment
8th June 2007	After Puls 200c ( By Another Doctor	Symptom date: 28th June 2007 Cyst Size measuring Right 2.9 x 5.2 cm left 5.9 x 4.8 cm another rounded thick walled cystic SOL measuring 3.4 x 4.2 cm. is seen in the Pouch of Douglas. Headache present agg on Journey and tension and from sunlight. Pain in ovarian region during/after urination and stool. Kind of nerve shock of mainly right leg during sleep. After, this leg cannot be straightened for 1 minute. Affected leg become sore for 1 –2 days. Could not control the urge to stool, as there was much stiffness of the lower abdomen. Menses last for 1-2 days. During menses soreness in lower abdomen with pain in both legs. Occasional pain in both ovaries during menses. Nails infection. Itching eruptions on anterior portion of both hinge joints of hands. Headache present. Constipation, piles with rectal fissure present. There was pain after stool.	The vaginal ultrasound showed the lesion progressing now to pouch of Douglas
9th July 07	After Ac Nit 200c (60 ml , 1/3, 1/3, 1/3)	Symptom date:- August 9, 2007 Rt Side Ovary there is an organized cyst of 2.98 by 2.76 cm Lt side Ovary there is a cyst of 2.45 by 2.22 cm. POD is free. Improvement in head ache. Pain in ovarian region after urination and stool was not there but reappeared in last three days. Nerve shock happened once during period on awaking. Happened again on 10.08.07. Can control urge to stool but slight discomfort present. Heaviness of lower abdomen before period and continued for first two days. Flow lasted for 2days. Third day there was a slight flow. Normal Flow. Just before flow she had stool four times, which aggravated her fissure and piles. Nails infection same. Itching eruptions on left elbow joint same, not much itching. Right elbow joint itch seems to increase in area with more itching. No rectal fissures. Piles are present	She aggravated for 12 days after this dose. Many symptoms improved but started to reappear. I asked her to repeat the dose after this report.
13th August 07	After Ac Nit 200c (180 ml , 1/3, 1/3, 1/3)	Symptom date:- August 28, 2007 Sonography not done. No Headache but a kind of heaviness (crawling sensation) is there particularly when awakening. Pain in ovarian region after urination and stool was not there. Nerve shock of the legs did not occur. Can control urge to stool. Flow last for 2-3 days. 1st day was very little (few drops). 2nd day watery flow. 3rd day was in clot (slimy thread like). No heaviness but on 2nd & 3rd days mild pain in lower abdomen. Nails infection same. Itching eruption of Left side has reduced in area but right side has increased in area with more itching. Constipation and rectal fissure is not there. Piles present. NEW Symptoms Teeth infection.	Her headache went away entirely as did ovarian pain after urine and stools, as well as the nerve shock. The dysmenorrhea was markedly reduced. She developed a tooth ache which went away shortly. This was her last menstrual period.
			The nail has improved! When I got this report we already knew she was pregnant. The pregnancy explains why some of her symptoms came back and she developed new symptoms probably due to adhesions from the endometriosis which had not had time to resolve.

The diagram above shows the ultrasound changes before and after treatment. There was only one ultrasound report after she took the miasmatic remedy and she subsequently got pregnant.

It may be argued that she may have got pregnant without the miasmatic treatment, but if you compare her progress in terms of symptoms that corresponded to the cysts disappearing from the pouch of Douglas, then it is highly probable she became pregnant because the cysts had regressed.

Note also the improvement in her nails as well as her general symptoms of headache and vertigo.

It would also be too much of a coincidence that she got pregnant after miasmatic treatment if it had not been curative to her infertility, because she had been married two and a half years without conceiving prior to miasmatic treatment.

No doubt at this point she still needed homeopathic treatment. She had become pregnant too early after the miasmatic treatment started and she still had adhesions in her abdomen from the endometriosis, also, while we did not know it at that time, she had small fibromas in her uterus that caused the placenta to implant in her lower uterus and hence the delivery was by Caesarean section. The fibromas were discovered during the C section. I continued to prescribe homeopathic remedies throughout her pregnancy and she managed to have a drug free pregnancy even though she had some discomfort due to the adhesions and the growing pregnancy.

Sumita gave birth to a healthy baby boy and is currently breastfeeding the baby that she delivered by Caesarean section on 11.05.08. I am continuing to record her progress and no doubt will have more to report when she starts to menstruate again and we can make an assessment of her reproductive system.

I have not reported on her ongoing treatment and will do so when the case is complete.

DISCUSSION

Sumita had been under the care of homeopaths for a very long time before I took over. What was not done in her treatment was to look into the miasmatic nature of her disease and to prescribe accordingly. While treating her for headache earlier, even though the headache reduced, her menses became more and more painful and as we saw later, her endometriosis became progressively more severe with more and more lesions found on subsequent ultrasound scans.

This is consistent with Samuel Hahnemann’s observation of Chronic Disease

"It was a continually repeated fact that the non-venereal chronic diseases, after being time and again removed homoeopathically by the remedies fully proved up to the present time, always returned in a more or less varied form and with new symptoms, or reappeared annually with an increase of complaints. This fact gave me the first clue that the Homoeopathic physician with such a chronic (non-venereal) case, yea in all cases of (non-venereal) chronic disease, has not only to combat the disease presented before his eyes, and must not view and treat it as if it were a well-defined disease, to be speedily and permanently destroyed and healed by ordinary homoeopathic remedies but that he has always to encounter only some separate fragment of a more deep-seated original disease. "Samuel Hahnemann” [11]

 I decided upon Nitric Acid based on the repertorizition and elimination from the lists of the Materia Virosa for the HSV2 state and the HPV state and from the dramatic response in which the cysts regressed. She subsequently became pregnant. It was a near perfect similimum to the miasm behind the disease. An aspect of the patient that was not addressed by the other homeopaths was her sensitivity to remedies. She only needed two doses of the remedy given in water as a split dose. She did not need multiple remedies either.

To take this one step further we chose to accept Shahrdar's viral miasms. Her symptoms are those of a viral state or a viral miasm. Sumita is having the HSV 2 viral state and possibly the HPV state although this does not come out very well in the RV analysis. It is to be noted that at any one time, one state will dominate and be uppermost and the other state will manifest when one state is cured by the similumum. This is consistent with what Hahneman pointed out in Chronic Diseases. At this point in the treatment I have not presented enough data to demonstrate this.

Conclusion

In my practice, Endometriosis has become a treatable disease and with the application of the Miasmatic theory, prescribing accordingly, the disease is not just palliated but cure is possible. It is my conviction that one day the medical profession will, via research, validate Dr Shahrdar’s[12] theory, that viral infections cause miasms in the body. [13]

Post note

It is now May 2009 and almost 2 years since I started her treatment in July 2007. Sumita has pain free periods now. Her treatment is still under my supervision and she is still having symptoms of chronic miasmatic states, but they are no longer endometriosis symptoms.

Further reading

Endometriosis, the homeopathic management, Suriya Osman IBPS publications,

Chronic Diseases, Samuel Hahnemann

Mary Lou Ballweg Endometriosis Source Book Published 1995

McGraw-Hill Professional ISBN: 0809232634

Minutus.org library

Copyright Dr Suriyakhatun Osman

May 2009