Acute disease or acute disorder is a very important aspect of the homeopathic management of disease and there are a number of distinct ideas and approaches regarding acute management. These vary from the belief that because an acute state is the crystallization of the inner state there is no need to prescribe separately for the acute because a constitutional medicine will treat this state, to the belief that in an acute, separate treatment is needed with a different medicine from the constitutional.
Also, the analysis pattern of each approach is different. Some look only for the physicals, some look for the mentals and some go with specifics. All these different approaches and ideas can be confusing. Which is the approach to follow? Which is the most true and reliable way?
From my experience of ten years practice I believe that all thoughts and approaches are true and reliable and I have successfully applied all of them, obtaining beautiful results from the different approaches.Let me explain how all of them are true and reliable. In some cases we observe that we hardly obtain any mental or holistic symptoms, and in some cases we have an extremely clear crystallization of an entire deeper state. In some cases we can clearly see the disturbance up to the physical level only, and in some cases we can see a holistic disturbance. In some cases we can see symptoms which are completely different from those that require constitutional medicine and in some cases we see only the symptoms of a constitutional remedy. In this way we have a different pattern in each case of an acute. Now the real question is how to understand these different patterns.
Let’s try to understand this scientifically.
This is the definition of acute disease from a medical dictionary:
“An acute is a disease or disorder caused by any external factor and appears suddenly, progresses rapidly and finishes either in death or recovery in a short time.”
From this definition we understand one thing very clearly, that in most acute cases the cause comes from outside the body. So, in short, acute disease is a state of disturbance where the body is under the influence of an external force like a viral, bacterial or fungal infection or is the effect of a sudden change from an external cause e.g. an injury from an accident, burns or poisoning. In order to understand the acute we need to understand the influence of external cause.
Let’s try to understand “External Cause”. Any external factors like bacteria, virus or fungi, attack the body suddenly and rapidly. Likewise the sudden effect of injury or poisoning causes a sudden change in the body and in both of these conditions the body tries to react or cope with the sudden change. The reaction to and coping by the system produces the symptoms in the body which we call acute disease. These symptoms take the form of physical changes, mental changes or holistic changes and these changes occur in proportion to the intensity of the external cause and the susceptibility of the system. This is the basic cause of the variety of symptoms in different acutes. In other words if the cause is strong or intense then the symptoms are also strong or if the susceptibility is high then the symptoms will reflect this.
Roughly we have four distinct patterns in acutes.
Patterns of Acutes:
(A) Susceptibility is high and cause is strong:
Before understanding this pattern let’s try to understand susceptibility.
Susceptibility is the state of being likely or liable to be affected, influenced, or harmed by something. So, the susceptibility is nothing but inherited weakness or genetic sensitivity towards certain disease or disorder or influence. If you are susceptible to something such as infection or influence it means you are sensitive to it and are likely to become sick with that infection or influence.
Bearing this in mind it’s easy to understand that whenever the susceptibility is high for an infection or influence then the overall state is vulnerable or sensitive to that particular infection or influence and the organism is prone to produce symptoms. So these symptoms are constitutional symptoms because the whole state is involved in the process of disturbance, so the person requires a constitutional medicine for an acute.
Generally a strong cause will produce strong symptoms and a generally deeper level of disturbance. So with this pattern it’s logical that a strong cause and high susceptibility will produce strong symptoms of the mind, physicals and the disturbance is mostly at the holistic level, so the whole state is crystal clear in the disease picture.
Here we have clear holistic picture of disease and a strong peculiar mental picture, so the person generally requires a higher potency starting from 1m onwards.
(B) Susceptibility is high and the cause is weak:
In this pattern the susceptibility is there, so the state is disturbed, but the cause is weak so we do not have a clear picture of disease and generally symptoms will be at the physical level with some mental symptoms, but they are not peculiar or clear. So, in this kind of case we have the physical picture of the constitutional medicine and the person requires a low potency, maximum up to 200c.
(C) Susceptibility is low and the cause is strong:
Low susceptibility means the state is not sensitive to a particular infection or influence and the constitutional state stays intact and the infection or influence produces a parallel state, so we then have an extra picture. In this kind of condition the cause is strong to produce a deeper disturbance, so we have a clear and strong picture of a medicine which is different from the constitutional medicine. Clear and peculiar symptoms and or involvement of a deeper level require a higher potency, 1m or more.
(D) Susceptibility is low and cause is weak:
In this kind of pattern the state is not disturbed, so we need a new medicine and as the cause is also weak we have physicals and some mental symptoms only and that’s why the potency is also low, up to 200c.
I see these patterns in my cases, but this is not complete and there may be other possibilities too. So, don’t stick to any rules, but these four different patterns give us a general map and criteria to select the medicine and potency.
Now, let’s try to understand these patterns from some case examples.
Acute Approach in management of acute disease
In this article we will discuss only the acute part of the whole four patterns. So, we have two cases in which an acute/new medicine is indicated.
A case of 7 years old girl had PUO (Pyrexia of Unknown Origin).
In all acute cases we first need to know all the changes that happened before, during and after the illness and secondly whatever changes are here at the present moment. Important too, during an acute attack the whole being is under the influence of the acute, so we need to know if the changes or symptoms are completely new or are they just older symptoms exaggerated. If all the changes are completely new and the person has never had them before then he requires an acute/new medicine. If the older symptoms are exaggerated then he requires his constitutional medicine.
D: I need to know everything that’s happened with Meeta before, during and after the fever and all the changes in her. So, please tell me everything in detail.
M (Mother): First I will tell about her problem. For the last 15 days she had a fever, every afternoon. We had a blood report and everything and the doctors cannot find a cause, so they have treated her with antibiotics and malaria treatment together. As she hasn’t recovered we decided to go with homeopathy.
D: When fever comes what exactly happens before, during and after fever?
M: Fever generally comes in the afternoon.
D: What time in afternoon? (Do not be satisfied with any information, try to make it as complete as you can.)
M: Around 4 pm it starts and within one hour it subsides. After 5 pm the kids come from school so then they eat dinner. As she eats something her temperature automatically goes down. We didn’t realize this at first, but one Sunday we were all out and were not able to eat anything till 8 pm and she had a fever till 8 pm and as we got home and she ate something then automatically her fever subsided. Now I understand what makes her better, whenever she has a fever I give her something to eat and the fever goes down within half an hour without paracetamol.
(We need all the peculiar changes which happen after an illness. Here we find a prominent and peculiar modality. In some cases the cause is prominent, in some cases the physical sensation or location is prominent. Whatever is peculiar and prominent we need to make more clear and complete and then on the basis of that prominent symptom we have the entire totality.)
D: Anything else?
M: Nothing more. She drinks a lot of water after the fever is subsiding. Since the fever she also rises frequently to drink water at night. That’s it. (Concomitant)
D: Now, tell me whatever changes happen in her mentally, emotionally and physically after the fever?
M: Yes, her nature definitely gets changed completely after a fever. Before she was good girl and never said anything in the presence of adults, but now she doesn’t keep anything inside. She will say anything to anybody face to face. She doesn’t respect anybody, even her teachers. She is always on her toes and ready to fight or answer back even over the smallest matter. Even if I ask her for a simple thing like “Do you wish to eat noodles?” and she answers this way… “I can eat poison also.” She is always rude and negative in answering.
D: All these changes happened only after the fever?
M: Yes, before this she was an extremely good girl and not only in our family but in our whole housing society she was everyone’s favourite.
(This question is very important to decide the pattern of the case. Does she require a totally new medicine or a constitutional one?)
D: Anything else you wish to say about her?
M: No. I’ve told you everything.
D: So, now please sit outside I wish to talk with Meeta alone.
M: Okay, no problem.
D: Tell me everything about your problem and whatever changes happened to you after the fever?
(Whenever we talk with the patient we need to confirm the information we obtain from the attendees and also whatever we observe about the patient during our conversation to the attendees.)
P (Patient): I have fever.
D: Tell me everything about the fever?
P: Fever comes in the afternoon and goes away automatically. The Doctor gave me a lot of medicines that I don’t like. It makes me weak and nervous.
(During our conversation with the patient we need to (1) Try to obtain more peculiar symptoms (2) Confirm all symptoms which we collected from the attendees (3) find out the desperation, pace and intensity of the illness (4) Find out at which level the acute has created changes)
D: Okay, when the fever comes, exactly how do you feel? Better or worse during fever?
P: Generally it comes at last period in our school and it goes when I reach home at 5 pm and eat something.
D: During the fever do you have any other problems?
P: No, nothing. Generally I lay down.
D: Tell me about any other changes in you after fever?
P: Nothing else. Everybody says I get angry very easily. That’s it. Can I go outside now?
D: Do you get angry?
P: Yes, if anything happens or somebody does anything that I don’t like then I get angry with them. Suppose, I say I wish to go to supermall and my brother says he wish to go at our uncle’s place, then I get angry.
D: What you feel at that time?
P: I feel as if everybody is against me. They never accept my choice. They always do whatever they want to do. So, I try to do everything wrong or opposite to them. I get angry with the slightest contradiction. I say to anybody whatever I wish to say even though they might feel bad or insulted.
D: What you feel when you get angry?
P: Anger stays for seconds after I talk with anybody.
D: Yes, during that few seconds what do you feel?
P: I feel as if everybody is against me, so I wish to do everything against them.
D: Yes, that I understand but during that few seconds of anger what do you feel deep within you?
P: Nothing happens deep within me, I just telling whatever I can. That’s it.
D: Okay, this kind of anger is there in you before the fever?
P: No. I was a very happy child and I never use bad words before. Everybody says I’m cute girl and I like to mix with everyone.
D: Your mother said you drink a lot of water?
P: Yes, doctor. Since the fever I like to drink lots of water especially after a fever. I never normally get up in sleep but now my throat becomes dry and I have extreme thirst during sleep.
First of all in each and every acute case we need to know the desperation or intensity of the acute changes. I.e. the effect of the acute influence on the person and what changes it creates. If deeper levels are involved then the person requires a higher potency. In this case the changes include some peculiar general modalities and some emotions, so it indicates the influence of acute is not so high so the potency she requires is up to 200c. The second thing in this case is that the changes are new, so her state is not so sensitive to this kind of acute influence so her susceptibility is low and she requires an acute/new medicine in lower potency.
All peculiar modalities and emotions lead to the medicine “Anacardium” but we cannot use the systematic understanding (Kingdom, Subkingdom, Source and miasm) of the case because the changes are not deep enough, so we only have physical general symptoms and some peculiar emotions.]
Prescription: Anacardium 200c two times a day.
Follow up after one day:
Moodwise she feels better and is not so angry during the day, but no change in the fever.
Prescription: Continue Anacardium 200c two times a day
Follow up after three days:
Fever gets milder and lasts for a shorter period and subsides without her eating within half an hour. She becomes calmer and her anger is less and less every day.
Prescription: Anacardium 200c till the fever subsides totally.
Follow up after six days:
No fever since the last follow up so no prescription of Anacardium
Prescription: Sac Lac
Follow up after 15 days:
No fever and she again becomes a good girl, no anger and she doesn’t use bad words any longer.
A 10 year old boy brought by his mother for recurrent fever.
D: Tell me everything about Jay?
M (Mother): For the last 3 months he has suffered with a fever. First time it was diagnosed as typhoid and was treated with antibiotics, but then it comes back again after 15 days and again antibiotics and now he has fever again, but he is not ready to take antibiotics. He says medicines are poisons. It comes every day on same time nearly 4 pm, now not so high just 99-100 F.
(Low grade fever, relative bradycardia and rise of temperature at evening or afternoon are common symptom of typhoid.)
D: When it was very high what kind of symptoms did Jay have?
M: Whenever he had a high fever he became hyperactive and couldn’t sleep properly; sometimes he sleepwalks. During his first attack 2 months ago he was delirious; we were so worried that he might become mad. He was moving from here to there constantly, did not stop until we gave him Dolo-650 (Paracetamol 650 mg) and the fever subsided. Sometimes he tried to run out of house, so we thought he might feel better outside , so we put his bed on the balcony. His sleep walking became less when he was on the balcony.
D: Talk about his Delirium?
P: During his fever at night he was screaming very loudly in his sleep and shouts help-help and fire-fire, and jumps out of bed. We went to his room and saw that he tried to run out of the room. He had wide open eyes and was very frightened. He had a completely red face and was just running and trying to escape; it was very hard to hold him at that time. We called a doctor immediately and he gave one injection and he calmed down a little more but as he tried to lay down or rest on the bed he suddenly jumped out of bed and start to run around the room. He feels better if we allow him to walk. Then after he sleeps a little bit, 2-3 hours he then gets up in the early morning again and starts walking in the room and starts murmuring something irrelevant and then till the afternoon of the same day he talks constantly.
(So, in this case we can clearly see that the disturbance is not limited to physical restlessness or physical generals or some mental emotions, but his entire being is disturbed because of acute influence. This indicates his disturbance is very deep and he requires higher potency.)
D: Now, I wish to talk with Jay alone, so would you please sit outside?
M: No problem.
D (To Jay): Jay, Tell me about your delirium. What exactly happened to you that night?
(We are confirming every detail that we obtained from the mother and want to clarify our systematic understanding of kingdom, sub-kingdom and miasm, because whenever the whole being is disturbed we have a clear picture at the deeper level.)
P: I was sleeping quietly and suddenly I felt that my chest got jammed (HG) I felt I can’t breathe and I will die soon, so I screamed and jumped out of the bed. I had one dream at that time; I see there is disaster everywhere, lot of scraps falling here and there and fire everywhere. I try to go away from there because if I am stuck there then there is no way out and suddenly my legs get jammed. I try very hard to move and run but I can’t. I wish to come out as fast as I can, so I push myself very hard but I feel breathlessness and I’m going to lose my energy. My anxiety is very high because I can’t breathe and feel as if I’m going to die any moment, so whatever energy I have I try and scream and try to run away. At that moment I get out of the bed and I’m awake.
(So, “Get jammed and not able to move” is the pattern that runs in the case.)
D: What happens when you wake up?
P: I was not able to take a proper breath and I was feeling as if my chest was jammed, that’s why I tried to go outside and wanted fresh air. The more I walk or run the better I feel, otherwise I get jammed both my legs and body. That was terrifying experience for me. I was very anxious and restless, I couldn’t get comfortable so I walked and walked till I’m tired then I rest and I feel the same as if I get stuck or my body gets stiff and I’ve lost all movement in me, even in breathing, so I get up and again walk.
D: What you feel when your body gets stuck, stiff and jammed?
P: It was the worst experience for me, as if I’m completely paralyzed, totally stiff like a statue and it’s not possible to make a move. I try very hard to come out of it, if I don’t try very hard then I feel might die in the very next moment. I feel as if my body, my bones, my muscles, and blood everything gets frozen in my body, there is nothing moving, so try very hard to make them awake and move to be alive.
D: Did you have this kind of same experience before?
P: Yes, doctor. Since I had this fever I had the same experience again and again. Whenever I have a high fever my body become stiff and everything gets frozen, but that stage passes away within fraction of second and then comes again after a while, so I didn’t bother too much about it but this time it stayed for a longer time so then I become anxious and try very hard to come out of it. I feel as if it’s my last moment of life, I’m going to die any moment. Everything gets frozen within short time.
In this case we see a clear pattern where all the symptoms and entire being is changed after illness, so the medicine which we need to prescribe is an acute/new medicine and because there is a deeper involvement of the whole being a high potency is required.
It is a crisis situation, something you have to do otherwise you may die within a short time. If you make an effort then you can save your life. This is the pace and desperation of the “Typhoid” miasm and oddly enough the patient is also suffering from typhoid fever. Now, we want a medicine which has the issue of get jammed, stuck, frozen, and stiff and the opposite is movement. These sensations are all of the Anacardiaceae family. So, Anacardiaceae family and typhoid miasm is Rhus tox. Now, let’s check the remedy from our traditional way of repertorisation…
Rhus tox 1m, twice daily till everything gets settled down and within 5 days his fever subsides and never returns thereafter.
So, this way I understand “Acute approach in management of acute disease”, and in next article we would discuss “Constitutional approach in management of acute disease”