Decoding Homoeopathic Therapeutic Strategy in Acute Glomerulonephritis (AGN) In Paediatric Practice

Terebinth, as acute remedy, in single dose was prescribed whic, brought prompt relief. It was followed by constitutional remedy Calc Phos to complete the cure. There was improvement of symptoms within 6 days.Follow-ups were maintained till four months without a relapse.

Nature has a surprise up its sleeves for everyone. Just when you feel you have understood the prescribing pattern based on assessment of susceptibility and Miasm in homeopathy, a surprise awaits us in the form of an exception. With humility andgrace we embraced it.

Case 8

8 year old female presented with signs and symptoms of edema grade 1, proteinuria+, hematuria+, and hypertension 160/100, loud S3 Audible with coarse crepitation in chest. All the complaints progressed within 2 days duration. The associated complaints were dry cough in short bouts, which is increasing during midnight.

She as a person had fear of darkness, animals and being alone. She felt jealous of others, cannot tolerate others if they won’t listen to her and try to dominate her. She is very irritable with violent shades of anger. She gets dreams of funeral, thermally hot and has craving for sweets.

Totality:

  • Fear dark
  • Fear of being alone
  • Fear of animals
  • Irritable from contradiction
  • Violent anger
  • Jealous
  • Dominating
  • Egoistic
  • Dreams of funeral
  • Hot
  • Craving sweets.

Discussion:

In this case the pace of the disease is too fast, with complications setting in early, patient with S3 audible and high BP is on the verge of going into left ventricular failure. Along, with that the patient has acute dry cough with short bouts <midnight with RS examination findings revealed coarse crepitation. On close observation one notes that edema is Gr I, proteinuria is Gr I and so is hematuria yet, the cardiovascular system is in overdrive.

From Miasmatic angle this case is lurking in transition between tubercular and syphilitic zone. There is risk due to cardiovascular overdrive and lurking tubercular-syphilitic miasmatic zone; the case might easily slip into complications like encephalopathy or LVF. Nevertheless, the good thing is there are a good number of characteristics at the mental, physical general and particular level.

In view of early of cardiorespiratory involvement, Syphilitic Miasm and midnight aggravation,Ars.iod 200 was given as the choice of the remedy in this condition. After the acute condition settled and cardiac overdrive calmed down, Lachesis 200, constitutional remedy was prescribed to complete the cure. Lachesis is an anti- syphilitic remedy which covered the mental symptoms and physical generals of the case; incidentally it is also complementary to Arsenic. Due to presence of a good number of characteristics, the 200 potency in single dose was prescribed. There was recovery of signsand symptoms in 6 days. There was follow up for 2 months. No relapse of symptoms.

Homoeopathic Therapeutic Strategy Table
Case #12345678910
Acute RemedyArsAlumiTerebiArs
IodnanthIod
Chronic RemedyOpiPulsLycoCalcCalc FlCalc SCalc PLachNatLyco
umCM
Ant miasmatic RemedyTUBTUBTUB
Potency Acute Remedy200200C200C200C
C
Potency Chronic200200200200200C200C200C200C200200C
RemedyCCCC
Potency Anti- Miasmatic1000C1000C1000C
Remedy
Repetition Acute331 DoseMultip
RemedydoseDosesle
s
Repetition ChronicSingSingSingl3FrequInfreqSingleSingle3Frequ
RemedyleleedoseentuentDosent
ses
Repetition Anti-SingleSingleSingle
miasmatic Remedy
Dominant MiasmPsoSycSycoSycoTubercTubercTubercTubercSycoTuberc
raosississisularularularular tosisular
Syphili
tic
StrategyCHAC –AC –CHCH ->AC- >AC ->AC ->CHCH ->
Acute(AC)/Chronic(CH)C>> CHICIC->CHCHIC ->
omplimentary (CO) Anti-COCHCH
Miasmatic (IC)
Recovery
0-4 Days44
4-8 Days666
8-12 Days101198
12-18 Days15
Follow Up Duration in3132114212
Months
RelapseNILNILNILNILNILNILNILNILNILNIL

Versatility is the key to managing the complexity of homoeopathic treatment in Acute Illnesses such as AGN. Thorough grounding in fundamental subjects of medicine, pathology, Organon of medicine and Materia Medica provide the launching pad for a homoeopathic physician to be versatile in practice.

CONCLUSION:

  1. Homoeopathy offers an effective and uncomplicated solution to the problem of Acute Glomerulo Nephritis with comparable or better outcomes as compared to conventional therapy.
  2. The principle of individualization remains the central theme for management of AGN in pediatrics. Scope of individualization has to expand to include not just the symptoms of patients but also the pace and stage of disease, clinic- pathological correlation, and quantitative assessment of susceptibility and qualitative judgement ofMiasm.
  3. Clinical observation of this study suggests that barring less than 20 % cases, almost all susceptibilities (individuals) did not throw characteristic particular symptoms (characteristic urinary tract symptoms) in the entire evolution of the disease.
  4. Most casespresented with common diagnostic symptoms of odema, proteinuria, hematuria and hypertension. Due to this peculiar trend of symptomology, individualization had to be based on per morbid constitutional attributes of the children.
  5. Remedy Selection in all the cases were based on understanding of symptomatology e.g. presenting symptoms, association of symptoms, pre- morbid attributes of patients etc. In short,the combination of symptoms presented by patient decided the individualistic homoeopathic approach.
  6. Going by the principle of individualization and respecting symptomatology patterns; Apis, Acetic acid, Apocynum, Natrum Mur, Cantharis etc. got vetoed out which are used more commonly as remedies in kidney disorders.
  7. As in this study, most cases, lacked florid characteristic symptoms of renal origin, hence understanding of pace of disease, stage of pathology and assessing evolution pattern of symptoms formed a vital trio to access dominant Miasm.
  8. This study revealed cases exhibiting all four Psora, Sycosis, Tubercular and Syphilitic Miasmas. Tubercular Miasm was most frequently encountered followed by Sycosis, Psora and Syhilitic Miasm as dominant in expression.
  9. Countering the Tubercular Miasm menace was an important strategy in resistant cases or those on the verge of life-threatening complications. The anti-miasmatic remedy Tuberculinum played a decisive role in facilitating cases which experienced miasmatic block, indicated by repeated short ameliorations or slow or non-registration of indicated homeopathic constitutional remedy.
  10. Management Strategy includes selection of first prescription, second prescription, potency and repetition. In most cases, constitutional drug was prescribed even though AGN is acute in nature. This had to be done because of the depth of pathology and multisystem involvement in a miasmatic illness. In addition, cases did not present with characteristic particular symptoms of kidney for acute remedies to get indicated.
  11. Cases which presented with characteristic particulars and concomitants were respected as in cases where Alumina, Ars.Iod and Terebinth were used as first and second prescriptions based on presenting acute totality.
  12. Posology and second prescription decisions such as selection of potency and repetition, introduction of anti-miasmatic remedy were based on assessment of Susceptibility, 2.Dominant Miasm3.Remedy Reaction .
  13. Most cases responded to single doses in moderate potency because pre- morbid characteristic symptoms were available to build constitutional totality. A small group of cases required repetition of doses mainly to counter the low responsiveness of susceptibility to homeopathic stimuli.
  14. SinceAGN is a rapidly progressive disease with life threatening complications like Encephalopathy, LVF and ARF, observation periods on placebo were relatively short especially in cases with dominant Tubercular and Syphilitic Miasms.
  15. For studies of diseases which are acute in nature with life threatening complications a cross-functional team of doctors is essential.
  16. Standardized recording system is absolutely essential for primary recording of case data. Homoeopathic Software “Organon 96” was used for systematic documentation and comprehensive analysis.

References

  1. (n.d.). In TEXT BOOK OF MEDICINE 6TH EDITION.
  2. Boericke, W. (n.d.). In A handbook of Homoeopathic Materia Medica.
  3. Boger, C. M. (n.d.). In A Synoptic Key to Materia Medica.
  4. Burt, W. H. (n.d.). In Physiological Materia Medica.
  5. Clarke, J. H. (n.d.). In A dictionary of Homoeopathic materia Medica.
  6. Cotran, R. (n.d.). In Pathologic Basis Of Disease 9th Edition .
  7. (N.D.). In Principles And Practice Of Medicine- 20th Edition.
  8. Dhawale M.L. (n.d.). PsoraSyphilis: miasmatic interpretation and clinic-pathological correlations with

comparisons. In C 5,Area C: Perceiving miasmatic evolution, ICR Symposium volume on Hahnemanniantotality, Part I, 3rd edition.

  1. Kasad K.N. (n.d.). Disease (Natural and drug):A phenomological approach, C1. In Area C: Perceivingmiasmatic evolution, ICR Symposium volume on Hahnemannian totality, Part I, 3rd edition.
  2. Kliegman, K. (N.D.). In Nelson Textbook Of Paediatrics 18th Edition.
  3. (n.d.). In S R. Materia Medica of Homoeopathic medicines.
  4. Samuel Hahnemann. (n.d.). In Organon Of Medicine, 6th Edition, Reprint Edition 2003. Ibpp Publishers.

Dr Kalyani Koya

M.D(Hom)

Assist Professor

Department of Community Medicine

JIMS Homoeopathic Medical College & Hospital

Navin Pawaskar

M.D (HOM), MICR (BOM), MHA(USA), CPDM(USA)

Healthcare Consultant

JIMS Healthcare

About the author

Navin Pawaskar

Navin Pawaskar
M.D.(Hom), MICR(BOM),MHA(USA),CPDM(USA).
JIMS Hospital, Hyderabad.
[email protected]
Mobile: +91 750 62 63 508”

About the author

Kalyanai Koya

Dr Kalyani Koya
M.D(Hom)
Assist Professor
Department of Community Medicine
JIMS Homoeopathic Medical College & Hospital

1 Comment

  • I found this an extremely valuable article. Drs. Navin Pawaskar and Kalyani Koya provide a an excellent model of how to proceed is such cases.

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