Abstract
Urolithiasis is a common surgical condition accompanied with much pain and anxiety. Homoeopathic medicines have shown a wide role in handling cases of urolithiasis. This case of urolithiasis is treated according to holistic principles of homoeopathy i.e. single, simple and minimum dose. Sepia 30 and Sepia 200 helped in expulsion of the stone with no side effects. The purpose of this report was to document the usefulness of the homoeopathic medicine “Sepia” in curing a particular case of urolithiasis, following the well-designed protocol.
Keywords: Homoeopathy; renal calculi; sepia; urolithiasis
STUDY DESIGN
The criteria chosen for working out the case in this study is as follows:
- Presenting complaints
- Clinical findings
- Ultrasonography findings.
- A predesigned scoring system for assessing the severity of the case quantitatively both at baseline (Table- 1) and successive follow ups, designed by Central Council for Research in Homoeopathy for its ongoing project on clinical research study on Urolithiasis.
- Homeopathic software (CARA) for selection of homoeopathic remedy.
The reason for the selection of several data collection modes (subjective clinical observations, scoring system and pathological test) was to more systematically and reliably evaluate the usefulness of homoeopathic therapy for patients suffering from urolithiasis.
The patient selected for this study was screened at the O.P.D of Regional Research Institute (Homoeopathy), Jaipur (first verbally, then written). He was enrolled after signing an informed consent agreement. Assessment at baseline and fortnightly assessment in-person for full clinical evaluation were done with the help of the scoring form cited below.
Table 1: Baseline scoring and assessment form
Assessment on First visit and subsequent visits
(Circle relevant number on each line) |
||||
1. Pain/colic | 0
No pain |
1
Mild pain |
2
Moderate pain |
3
Severe pain |
2. Haematuria | 0
No Haematuria |
1
Microscopic |
2
Persistent |
3
Gross |
3. Dysuria | 0
No Dysuria |
1
Mild Dysuria |
2
Moderate Dysuria |
3
Severe |
4. Stone | 1
Single stone |
2
Multiple stone |
||
5. Size of stones | 0
Gravel < 3mm |
1
3 mm – < 4 mm |
2
4mm – < 5 mm |
3
5 mm and above |
6. Position of stone kidney | 0
no stone in kidney |
1
Pelvic ureteric junction |
2
Pelvis of kidney |
3
Calyces of kidney |
7. Position of stone ureter | 0
no stone in ureter |
1
Lower part of ureter |
2
Middle of ureter |
3
Upper part of ureter |
8. Position of stone bladder | 0
no stone in bladder |
1
Base of bladder |
2
Intramural ureter |
|
Total scoring – 22
Symptoms score – (Sum of 8 circled numbers) 1-7 mild 8-14 moderate 15-22 severe
|
The patient screened from O.P.D with the following inclusion criteria:
- Burning Micturition
- Pain in lumbar region
Once the patient was successfully screened, informed consent was signed and he was sent for investigatory procedures along with complete case history (presenting complaints; including location, sensation, modalities and concomitants, history of presenting complaints, family history, past history, treatment history, physical and mental generals). Simultaneously the patient was quantitatively assessed as per the baseline form mentioned above.
Case Summary
Mr. H, is a 20 year old male student, unmarried, with a diagnosed case of urolithiasis having renal calculi of 5 mm in the middle calyx of right kidney and a calculus of 5 mm at UV junction of left ureter showing mild hydronephrosis, mild hydropelvis, mild hydroureter with severe pain, nausea, cramps in abdomen, came in the OPD in Oct’07 (after taking Allopathic treatment), at Regional Research Institute for Homoeopathy, Jaipur (Regd no.- 2356/07).
The patient presented with:
- Pain – drawing, lumbar region for 7 months
- Extension – start from lumbar region (left) to abdomen
- Modalities – Aggravation- pressure, sitting
- Amelioration- on lying down on back
- Concomitants- Anxiety pain during
- Sensation of pain – drawing sensation
- Pain burning in urethra before and during the Micturition for 7 months.
- Nausea aggravated in the morning.
Patient comes from a very well to do family. His childhood was good and uneventful. He was a much pampered child in his family. He is very much concerned about people’s rights and justice. He has a great fear of injury as he can’t go for the blood test and any other surgical process for the removal of the stone. He says that his friends eat the same foods that he does and nobody has this calculus problem. He is not happy with his friends’ healthy status. He feels that he is lacking a healthy state as compared to his friends.
The patient has a great desire for apples and has profuse perspiration on soles and palms.
On examination it was found that he has fair complexion, obese body build, weight 74kgs, and height 164cms. On palpation there was a deep tenderness on left lumbar region.
Table 2 : Baseline Assessment on First visit
Assessment on First visit | ||||
1. Pain/colic | 0
No pain |
1
Mild pain |
2
Moderate pain |
3
Severe pain |
2. Haematuria | 0
No Haematuria |
1
Microscopic |
2
Persistent |
3
Gross |
3. Dysuria | 0
No Dysuria |
1
Mild Dysuria |
2
Moderate Dysuria |
3
Severe |
4. Stone | 1
Single stone |
2
Multiple stone |
||
5. Size of stones | 0
Gravel < 3mm |
1
3 mm – < 4 mm |
2
4mm – < 5 mm |
3
5 mm and above |
6. Position of stone kidney | 0
no stone in kidney |
1
Pelvic ureteric junction |
2
Pelvis of kidney |
3
Calyces of kidney |
7. Position of stone ureter | 0
no stone in ureter |
1
Lower part of ureter |
2
Middle of ureter |
3
Upper part of ureter |
8. Position of stone bladder | 0
no stone in bladder |
1
Base of bladder |
2
Intramural ureter |
|
Total scoring – 13
Symptoms score – (Sum of 8 circled numbers) 1-7 mild 8-14 moderate 15-22 severe
|
Follow up of the patient was done periodically at fixed intervals as per protocol. A medicine, most similar to the totality of symptoms, is to be derived after analysis and evaluation of the case and framing of the conceptual image of the patient and conversion of his symptoms to rubrics and Repertorisation by CARA Repertory.
The Repertorisation Chart is given in Table -3.
Repertorial analysis and evaluation
Calc 16/9, Nux Vom 16/9, Sulph 16/9, Sep 13/8
The prescription was based on totality of symptoms and repertorial analysis. The repertorial sheet shows that the mental picture of the case is covered by SEPIA in a more complete form than any other drug. Mentals always rules over the particulars.
The follow ups along with the scoring of the case are given in Table -4
Table-4: Follow-ups along with entry score | ||||
At entry | Follow ups | |||
Date | 27.10.07 | 7.11.07 | 25.2.08 | 24.3.08 |
Patient as a person | · Injustice, cannot support
· Envy · Fear injured of being · Anxiety pains, from · Food and drinks apple desires · Nausea morning · Perspiration general hand, palms · Perspiration general foot sole · Pain general Ureters · Pain general Ureters left side · Pain drawing Ureters left · Pain general, lying while amel. back, on · Pain general , pressure, on · Pain general, sitting while · Pain burning Urethra, urination agg. before · Pain burning Urethra, urination during
|
· Pain was static with no anxiety
.
|
Severe Pain in abdomen and kidney, with burning in urethra during and after urination
USG shows calculus at right UV junction calculus 0f 8 mm (earlier in middle calyx). No calculus at left ureter (earlier was at UV Junction). |
No pain, patient reported the expulsion of stone.
Since then patient is continuing the follow up with placebo only. USG was done on 1.05.08 shows normal study of KUB region. No Calculus at all was found in KUB Region |
Score | 13 | 9 | 11 | 00 |
Medicine | Sepia 30 / one dose
Placebo / BD for 7 days |
Sepia 30/ one dose
Sac Lac / BD/ 15 days |
Sepia 200, 1 dose
Sac Lac/BD/15days |
Placebo / BD/15days |
Table 5: Showing the Ultrasonography observation on different dates
USG Done | Date
20.10.07 |
Date
25.2.08 |
Date
25.6.08 |
Right kidney |
Normal study of KUB region
|
||
Location of calculus | Middle Calyx
|
Right UV Junction
|
|
Size of calculus | 5 mm | 8 mm | |
Left Ureter | |||
Location of calculus | UV Junction | No calculus | |
Size of calculus | 5 mm | Nil |
Discussion
This case belongs to moderate intensity according to the baseline scoring of the case which is designed for the protocol of the project.
The group of drugs arrived at are Calc 16/9, Nux Vom 16/9, Sulph 16/9, Sep 13/8. The repertorisation result is never the end of the search for the simillimum. The final court of appeal still remains the Materia Medica in deciding on a prescription. After the group of drugs arrived at by repertorisation, the mental picture was always an important objective and included in deciding on the prescription. Accordingly, drugs arrived at after repertorisation were shortlisted. Calcarea carb failed to be considered for prescription as the constitution of the patient and other generalities of the drug were not in favour of its prescription. Nux vomica was dropped from the list because of the lack of irritability and the lifestyle of the patient (fastidiousness, sedentary habits). Sulphur, the third one, was excluded because of the absence of the typical Sulphur personality.
The prescription for the case was Sepia 30, one dose, keeping in view that it covered the mental picture better than any other drug. Homoeopathy does not consider numerical totality only, the mentals usually rule over the physical similarity. “Mental symptoms and emotional symptoms are of paramount importance not only when prescribing for mental and emotional conditions, but also when prescribing for physical symptoms”1. The mental symptoms reflect the deepest aspect of the patient who experiences them and the remedies which evoke them; in many cases they take precedence over general and local symptoms, even when these have constituted the original complaints. When correctly selected and matched they can lead to a lasting cure2. So in this case Sepia is the most suitable drug which covers the patient’s envy. In Sepia, this frequently lies at the root of discontent. He abstractly envies others for their good fortune and success3. Here the patient thought that none of his friends have suffered from same problem he is facing. They all stay together, go out and eat same stuff but only he is the sufferer, so he was not happy with their good health. Sepia chronically worries that others have something he lacks3.
Another prominent Sepia modality is the left sidedness of many complaints. In the occult sciences the left side has traditionally been regarded as pertaining to the emotions, the irrational and the unconscious, while the right side represents the intellect, rationality, and consciousness. Thus, his predominantly left sided symptoms are yet another way suggest an imbalance of the emotional, rather than the intellectual, sphere3.
It is traditionally known that Sepia produces “Pain like knives shooting through the uterus spasmodically, lancinating pains in the uterus shooting upwards, pressure in the uterus as if everything would issue through the vulva, and the pressure downward is as if everything would fall out”4. From this we understand that Sepia produces its spasmodic action on the uterus and expels the product through the vulva, so why not in the case of Urolithiasis, in would spasmodic action helped in the expulsion of this stone.
The cure of the part should not be attempted without treatment of the whole. Plato stated that no attempt should be made to cure the body without the soul.
Every physical disharmony is accompanied by a change in the mental/emotional sphere and vice-versa. How then can any medical system
that views them as separate and which treats them separately, be effective?
This is why the basis of ‘holistic’ medicine is that these are not
regarded as separate but simply aspects of the ‘whole’1.
Therefore homeopathy, a holistic system, which always honours the body-mind connection, both in the case taking and in the choice of remedy. Its remedies are effective for, and simultaneously treat, both mental/emotional and physical conditions, whether they appear to exist separately or together1.
Follow Up
The follow up of the patient was made and evaluation of the result was arrived at by comparing the observation with the baseline assessment. During the course of follow up, the second Ultrasonography done on 25th Feb 08 , shows a calculus on the right side which came down to UV junction from right middle calyx, but the size given by the radiologist 8 mm . while in earlier ultrasonography report was 5mm calculus in the right middle calyx. Our consultant and radiologist are of the view that this could be the error of judgment due to a different location; observation in the ureter is more accurate than in the calyx.
The objective has been achieved to the extent that homoeopathic medicine in potency is useful for the expulsion of stones following the classical Hahnemannian approach. Symptoms of the drug Sepia upon which the prescription was made, are confirmed and this reveals the fact that mind rules over the physical to a large extent.
Conclusion
Homoeopathic medicine in potency selected on the basis of the totality of symptoms has a useful role in expulsion of renal calculus. The spontaneous expulsion of stones of lower size has been ruled out as this patient continued under conventional treatment for more than 6 months without result. Only after homoeopathic treatment did expulsion take place.
This is the case which shows the unique action of Sepia in treating Urolithiasis on the basis of mental symptoms specifically. As far as the available homoeopathic literature is concerned, it is not mentioned that sepia can be used for the cases of Urolithiasis. So the conclusion is that homeopathic medicines are largely broad spectrum, capable of inducing healing in many kinds of diseases. Every patient requiring a particular remedy will not have all the indications of the remedy. Again, every remedy will not have all the symptoms of the patient. The attending physician makes the selection of the remedy when he or she looks at the case as a whole5.”
REFERENCES
- Simon King Homoeopathy_Help.net; Guernsey; 2004-2008; Emotions and Mental Symptoms in Homoeopathic Case Taking. Available from:http://www.homepage.ntlworld.com/homoeopathy_advice/theory/intermediate/mind.html accessed on 09.07.08
- Detinis Luis, Churchill J.N translator, Mental Symptoms in Homoeopathy; 1st edition; U.K; Beaconsfield Pub1994.Available from: http://www.wholehealthnow.com/books/mental-symptoms accessed on21.06.08.
- Coulter R. Catherine , Portraits of Homoeopathic Medicines; California; North Atlantic Books;1986;139-141
- Allen T.F , The Encyclopedia of Pure Materia Medica;reprinted 1986;India; B.Jain Publishers(p)ltd;8;633
- Shah Rajesh Life Force Homoeopathy; India; 2008; Understanding Homoeopathic Medicines; Available from:http://www.classicalhomoeopathy.com/medimore.html accessed on 08.07.08
DRS,
I HAVE TREATED SEVERAL CASES INCLUDING MINE OF RENAL CALCULI UP TO 6MM WITH 2 REMEDIES NAMELY BERBRIS Q AND SARSAPARILLA Q TWO DOSES OF EACH ALTERNATELY EVERY DAY AND DRINKING LOT OF WATER UP TO EXPULSION OF STONES
THANKS