The Acute Prescription Part 1– Making It Easier

This article is an attempt to share some of my views and tips in treating acute diseases and to boost confidence in prescribing. After the intense summer heat, we welcome the rain, the cool breeze and the greenery. But this rain brings challenges to doctors treating various infectious diseases like dengue, malaria, chikungunya, typhoid etc. As homoeopaths, we face many challenges in treating such infectious diseases and its complications (post dengue joint pains, various allergies and neuralgia’s). As it is rightly said, “If you want to see the rainbow you have to deal with the rain”. And to deal with such rain there are these following salient features which you need to keep in mind.

1. CAUSE
2. PACE
3. PECULIAR SYMPTOMS (physical or mental)
4. MODALITIES
5. PHYSICAL GENERALS (thermals, thirst, urine, stools, sleep ….etc.)

Before we look at some remedies and their salient features, I would like to emphasize a detective like approach to eliciting symptoms and to understanding the peculiarity in each case. To understand this, I would like to share one of the important cases which made me realize the significance of this approach.

A middle aged female came to me with complaints of cough with dryness. Cough started after having a cold drink. The cough was suffocating, making her anxious along with having palpitations and slight hoarseness of voice.

Modalities:

Aggravation morning and cold drinks

Amelioration warmth and warm drinks.

So looking at the salient features:

1. CAUSE- Cold drinks
2. PACE- Rapid
3. PECULIAR SYMPTOMS- Cough with dryness, suffocating cough, anxiety with cough, palpitations, hoarseness of voice.
4. MODALITIES – Aggravation morning, cold drinks. Amelioration warmth
5. PHYSICAL GENERALS- No change in thermals, thirst, sleep …etc.

Summing up all the above symptoms I gave a few remedies, including Hepar Sulph, Spongia, Bryonia etc. But the patient was not better even after a week. As these were the initial days of my practice I was determined and I retook the case with a desperate desire to find some peculiar symptoms. During the enquiry, the patient emphasized having the cough, especially in the morning. So I asked, “Why is your cough aggravated in the morning?”

Patient said, “I don’t know.”

I asked, “When is your cough aggravated in the morning?”

Patient says, “I don’t know.”

So, I ask, “What time do you wake up?”

“6 a.m.”

“Do you have cough at that time?”

“No.”

“Then what do you do?”

“I brush my teeth, go to the toilet, do my daily routine.”

“Do you have cough at that time?”

“No.”

“Then what do you do?”

“I go down to get water.”

“Do you have cough at that time?”

She says, “Yes, my cough starts at that time.” (Many times we stop here and take modalities like aggravation water. This is where we have to be very careful to see exactly what is affecting the patient here, so I keep enquiring)

I continue, “So what if you have to get water, why does it start at that time?”

Patient: “My house is on the first floor and I have to go down one floor to get

drinking water. Whenever I am climbing stairs on my way back my cough starts, I get breathlessness with anxiety, suffocation.”

“Then what do you do to reduce the cough?”“I have to sit down for my bout of cough to reduce. And in fact this happens whenever I have to go out of the house and come back.”

So, we understand here that the main modality was not morning or cold drink but aggravation on climbing stairs.

In Phatak’s repertory we find the rubric:

Cough on ascending stairs – ARGENTUM NITRICUM is the single remedy.

Seeing the hoarseness of voice, suffocation and anxiety we understand that Argentum  Nitricum is the remedy. So if we are able to find out one such peculiar symptom with a detective kind of approach, then everything falls into place.

Remedy Tips

 Considering that you all will be eliciting the salient features with such a detective approach, I would now like to focus on giving some tips on the use of certain remedies in managing acute cases, with a few case examples.

We have the first cause as ailments from (A/F) getting wet in the rain with the following differentiation. So, once a patient came to me with complaints of cold, runny nose after getting wet in the rain with a lot of sensitivity for cold air, especially on the nose and the forehead. She always needed to cover the nose or face with a hand or handkerchief. The remedy that helped her was DULCAMARA. When we have symptoms of pain in throat with yellowish expectoration, after drinking cold water while playing, working in farm or during any physical exertion, then most commonly we think of the remedy Rhus tox.  But the remedy is BELLIS PER, a  Bellis Per also has ailments from getting cold immediately after being heated like Rhus Tox. If there is pain in the muscles or body ache after getting wet in the rain while being heated, then the remedy is Rhus Tox. However, throat infection after drinking cold water when heated is Bellis per.

If getting wet in rain after being heated is the cause with complaints of cough, dryness of throat, constipation and increased thirst the remedy is BRYONIA ALBA.

A child who has asthma during rainy season calls for the remedy NATRUM SULPH.

During the rainy weather, we see growth of grass and plants. If a patient develops allergic symptoms due to these with symptoms like sneezing, runny nose, extreme sensitivity to cold air which later on results in bronchitis, pneumonia with a lot of yellowish thick expectoration from the chest, the remedy is DULCAMARA.

Cause: GETTING WET IN RAIN

SR.NO	CHARACTERISTIC  INDICATION	REMEDY
1.	Cold with runny nose. Sensitivity to cold air on nose and forehead.	Dulcamara
2.	Pain in throat with yellowish expectoration	Bellis Per
3.	Muscle pain	Rhus tox
4.	Cough with increased thirst Constipation	Bryonia Alba

Coryza with COPD (chronic obstructive pulmonary disease) along with a sense of suffocative obstruction in respiration calls for JUSTACIA ADATHODA.

If coryza with obstruction in the nose and patient wakes up with asthma at night, the remedy is ARALIA RACEMOSA. Similarly, if we have asthma especially at night while falling asleep with lot of mucus in the chest, then the remedy is GRINDELIA.

RESPIRATORY AFFECTION

SR.NO	CHARACTERISTIC INDICATION	REMEDY
1.	Asthma in rainy season	Nat sulph
2.	Bronchitis in rainy season Yellowish thick expectoration	Dulcamara
3.	Coryza with COPD with suffocative obstruction	Justacia Adathoda
4.	Coryza with obstruction in nose	Aralia Racemosa
5.	Asthma with lot of mucus in chest only at night	Grindelia

Another causative factor which is common is cold weather and sensitivity to cold. The top most remedy here is NUX VOMICA. It is one of the most chilly remedies in our material medica. The typical picture of NUX VOMICA which we find is a patient who had been to a party, where he had lots of oily /rich food, alcohol etc. Next day early in the morning he starts having very intense chills with rigors which are not ameliorated even after 2-3 coverings, wants all doors and windows closed. There is suddenness and intensity with which the chills begin and the patient gets admitted to the hospital. Then he starts having ineffectual urge to urinate/stools/eructate or vomit. He says “If I could only vomit/eructate completely/urinate/pass stools completely I would feel better.”

Next remedy for chilliness is HEPAR SULPH. In Hepar Sulph there is the same intensity of suddenness and chilliness as Nux Vomica but the pathology gets localized in throat. There is severe throat pain extending to the ears.

One remedy which comes close to Hepar Sulph is CISTUS CANADENESIS. Extreme sensitivity to cold air with throat pain with the sensation as if cold air is reaching inside the throat.

Similarly, there is RUMEX with same sensation as if cold air is reaching inside the throat but in Rumex there is no pain but tickling in the throat which causes cough.

Another remedy relevant in today’s modern world is ARUNDO which has A/F polluted air causing complaints of asthma, allergies, itching in the nose and palate.

CHILLY REMEDIES

SR.NO	CHARACTERISTIC INDICATION	REMEDY
1.	Aggravation oily rich food Chilly patient Ineffectual urge for stool, urine, eructation etc.	Nux Vomica
2.	Suddenness Chilly patient Throat pain extending to ears	Hepar Sulph
3.	Sensitivity to cold air Throat pain when cold air reaches the throat	Cistus Canadenesis
4.	Sensitivity to cold air – Tickling in throat when cold air reaches the throat	Rumex
5.	A/f : polluted air Itching in nose and palate	Arundo

Speaking of chills with sensitivity to cold, some diseases which comes to mind are fevers like Malaria, Dengue, chikungunya, abscesses, urinary tract infections etc. In all such fevers there can be any 3 stages.

1) Chill 2) Heat 3) Sweat. When we have all the 3 stages along with periodicity, like chill with shivering, rigor followed by intense heat and profuse sweating coming every night at around 10pm with which there is profuse loss of vital fluids which may be in the form of vomiting or diarrhoea or menorrhagia

or any kind of blood loss, then the remedy is CHINA OFFICIANALIS. China is also an important remedy for Meningitis with desire for stimulants, refreshing things.

Another important remedy for fevers is EUPATORIUM. Eupatorium is generally needed in people who have been to a forest camp. They develop all

the three stages of fevers with the characteristic chill beginning in the thoraco-lumbar region. Along with this they have intense joint pains or bone pains.

Another important indication for Eupatorium is pain in finger joints, elbow joints with deposits after dengue or malaria. Dropsy or swelling along with pain in lower extremities which has remained since months after fever.

In the same way, Anasarca after fever with urticarial rash is seen in DULCAMARA.  NATRUM MURIATICUM has lots of chills followed by heat and periodicity. The peculiarity is that during the heat there is dryness which is seen on the lips along with cracks at the corners of the mouth, lower lip or eruptions around the mouth with dry throat. There is increased thirst

with pain in throat just above the sternum. The location on throat is peculiar to Nat mur.

FEVER WITH ALL 3 STAGES:

SR.NO	CHARACTERISTIC INDICATION	REMEDY
1.	Profuse loss of vital fluids Fever with periodicity	China Offficianalis
2.	A/F   forest trip Chill starts in thoracolumbar region Intense joint pains (post dengue or malaria) dropsy	Euphatorium
3.	Anasarca after fever and urticarial rash	Dulcamara
4.	Dryness in heat phase Cracks in lips with eruption around mouth Dry throat with increased thirst	Natrum Muriaticum

One frequently encountered case is of a new student who has just joined a new

college/hostel or a new job in a new city. For him everything is new and strange. The food, weather, new people which causes anxiety, loss of sleep, appetite along with weakness and frequent long continued infections like cold, cough with offensive yellowish expectoration and chilliness which stays for months. The remedy indicated here is SILICEA.

Similarly, another remedy which is aggravated due to change from day to night that is during sunrise or sunset is PHOSPHORUS. Along with this you will observe redness and congestion of face, suffocative cough and pulmonary hypertension.

A/F NEW PLACE COLLEGE, HOSTEL/NEW JOB

SR.NO	CHARACTERISTIC INDICATION	REMEDY
1.	Anxiety with sleeplessness Long continued infection like cold with offensive yellow expectoration Chilliness	Silicea
2.	Aggravation from sunrise to sunset Redness and congestion Suffocative cough and pulmonary hypertension	Phosphorus

Video 1 :-https://www.youtube.com/watch?v=K3VI845Zj-s&t=28s

 

Video 2 :- https://www.youtube.com/watch?v=VCHeEWgyCjI

 

Video 3  :- https://www.youtube.com/watch?v=orT9WlnFGhA&t=37s

 

Video 4 :- https://www.youtube.com/watch?v=lYqrAUa-U7w

 

Video 5 :- https://www.youtube.com/watch?v=RIs-qSaiBkg

 

Editor’s Note:  See Acute Prescriptions Part 2 next month.