Siicea -A Non Excisional Therapeutic for Lymphadenopathy

 Abstract– Post viral or bacterial lymphadenitis is a common sequel encountered in day to day practice and most commonly seen in the paediatric and adolescent age group due to lack of proper nourishment. 90% of the age group between 4-8 years present with lymphadenitis of acute origin whereas in adolescent age group chronic lymphadenitis is commonly viewed in today’s world.

In Tropical countries there is rampant tubercular lymphadenitis which needs to be diagnosed at the earliest to avoid spread to other organs. Proper homoeopathic treatment with proper clinical understanding replaces need for surgical excision.

Keywords- Boger, Hahnemann, Silica, Pathological, Kikuchi Fujimoto, Chronic, Cervical Lymphadenitis, Tuberculosis, Boericke, Phatak, Clarke, Materia Medica.

 Introduction– Bacteria such as tuberculosis, staphylococcus aureus, Streptococcus and viruses like influenza and Hemophilus A and B are known to cause chronic lymphadenitis in earlier age groups. Depending on the etiological factor the prognosis of the case is defined.

India being the epitome of tuberculosis, it has to be ruled out before treatment as it medicolegal responsibility to notify case of tuberculosis to prevent its spread further and to establish and identify cases of drug resistant tuberculosis.

 Case History-

A 15-year-old boy comes to the OPD with chief complaints of

swelling on right side of the neck since 3 weeks <4-5 days

O- Gradual P- Increasing

Sensation- Pain on pressure

> applying Balm

H/O- Fever (1 episode) 2-3 months back with Weakness and Fatigue

No H/O- 1. Cough

2. Coryza
3. Weight loss
4. Night sweats

Patient As A Person: –

Likes- Sweets ++

Thermal Reaction- HOT+3

Past History – Malaria 5-6 years back

Family History- Grandmother- Hypertension and Diabetes

Mental Characteristics-

Anger++ when someone blames him for something he hasn’t done. Retaliates by shouting at them without any grudges.

 Investigations (7/5/2021)

CBC

1. Hb- 13.1 g%
2. RBC count- 5.23 million/cu mm
3. Total WBC Count- 6900/cu mm
4. Platelets- 186000/cu mm

ESR- 10 mm at 1 hour

Local examination-

Inspection-

1. a circular mass on the right side of neck just below the angle of mandible
2. Skin colour
3. Size- 2-3 centimeters in diameter.

On Palpation-

1. No heat
2. Consistency- Firm
3. Fluctuant mass
4. Tender on pressure

Lymph nodes- Mildly palpable on both sides (but not visible)

Investigations Advised-

1. Fine Needle Aspiration – Rule out Kochs
2. X ray chest PA View

(Patient had already been to a surgeon and he had advised to get a biopsy done but the relatives didn’t want to get any operative procedure done so they denied to get an FNAC done)

Fig 1. Right Cervical Lymphadenopathy.

Figure 2: – X- Ray Chest PA revealed increased bronchial markings. Both costophrenic angles normal.

Differential Diagnosis

Provisional Diagnosis: Chronic Cervical Lymphadenitis, ICD Classification – I88.1

Reasons-

• Time duration- 3 weeks
• No signs of acute inflammatory changes
• Tenderness is present at the site.
• No night sweats, sudden weight loss, anorexia,
• ESR- 10 mm- TB lymphadenopathy ruled out.

Hahnemannian Disease Classification- Dynamic, Chronic, Miasmatic with fully developed Symptoms.

Paucity of Symptoms–

One comes across cases in which, in spite all the efforts of a physician, the case record is very poor in symptomatology. The symptoms that depict the individual are conspicuous by their absence. The few symptoms that are available indicate merely the changes that occurred in tissues and organs.

Miasmatic Understanding:-  

Fig 3: Miasmatic Understanding.

Boger’s Approach

“With an enormous increase in available pathogenetic symptoms we do not feel this need so acutely, albeit often to our own disadvantage. Most prescribers gradually enlarge the scope of their remedies quite beyond their seemingly legitimate sphere of action. This springs from the fact that the simillimum releases reactive power strong enough to re-establish harmony, which in turn is capable of sweeping away almost any morbid condition.”

Totality-

1. Anger- contradiction from
2. External throat Right Cervical glands swelling
3. Pain in cervical glands
4. Thirstless
5. Perspiration- axilla
6. Sweets desire
7. Hot patient

Fig 4: Reportorisation sheet.

 Table 1: Differentiation of the remedies

Remedy- Silicea

REASONS-

• Hard swelling of cervical glands
• Malnutrition of children
• Perspiration of axillae
• Desire cold water
• Anger on contradiction
• Kents Materi medica has mentioned that there is extreme heat intolerance in Silicea Patients.

Susceptibility- Low

1. More pathological symptoms compared to generals.
2. No characteristics seen at the level of generals.
3. No prodromal symptoms seen.
4. Chronic Disease
5. Slow Pace of disease
6. Low Sensitivity at the level of mind and body

POSOLOGY- SILICEA 30 qds

REASONS-

• More pathogenetic symptoms than general symptoms
• Low Susceptibilty
• Absence of prodromal and functional symptoms
• Syco- Tubercular Miasm

Reference (Symposium Volume 2)

Pathological Prescribing- At times in a chronic case with advanced pathology, there is a lack of clear cut indications for the chronic constitutional prescription, due to paucity of characteristics and concomitants. The striking pathological condition indicates the remedy in such cases. It needs to be prescribed frequently in low potency.

 Ancillary Mode of Treatment-

• Vitamin Supplementation- Vitamin C, Vitamin B12, Vitamin D3 and Calcium.
• Proper nutritious balanced diet to be followed.
• Add protein to diet to build immunity.

Follow Up Criteria-

• Swelling of the right side of neck
• Generals
• Any New Complaints

Fg 5: 22/5/2021

Fig 6: 29/5/2021

Case Learning-

• Application of Boger’s Approach in pathogenetic conditions
• Prescribing when there is paucity of symptoms
• Clinical approach to lymphadenitis cases
• Miasmatic Study- Syco tubercular miasm.

Acknowledgement: –

We thank Dr Mohanbhai Patel, Chairman, The Homeopathic Education Society (Smt. Chandaben Mohanbhai Patel Homeopathic College), Dr Asmita Parikh; General Secretary, The Homeopathic Education Society (Smt. Chandaben Mohanbhai Patel Homeopathic College) and Dr Parizad Damania- Principal, Smt. Chandaben Mohanbhai Patel Homeopathic College for the encouragement, support and hospital infrastructure.

Corresponding author:  Dr Rakesh Gupta, President of Satva Charitable Sanstha. HOD and Associate Professor, Forensic Medicine and Toxicology, Smt Chandaben Mohanbhai Patel Homeopathic Medical College, Mumbai, India.

BIBLIOGRAPHY-

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2. Kikuchi- Fujimoto Disease

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1481509/#:~:text=Kikuchi%2DFujimoto%20disease%20(KFD),nausea%2C%20vomiting%2C%20sore%20throat.

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