When treating arthritis, and infection from a virus or bacteria comes in the way of progress, that condition must be dealt with as an acute, not chronic one. A deep acting miasmatic drug must not be applied here. When an antimiasmatic drug is given during this acute condition, the case becomes an obstinate one. After that, even acute medicines stop acting, and the case is lost. We have to deal with the acute infection. This acute infection should be treated from the aspect of acute disease.
Allied abnormalities are one of the main obstructing causes I have found, which come in the way of treating arthritis. In one difficult case I treated, the patient was suffering from pain at the lumbo-sacral region, with pain radiating towards the legs, aggravation from rest and relived from movement. The pain was intolerable at night and while lying down. X-Ray showed degeneration of bones at the sacro-pelvic junction. On palpation the junction was sensitive to the least pressure and relieved from moderate heat application. The pain was aggravated also in the morning from first movement and relived from continued movement to some extent. This patient was a male, 41years of age. I prescribed Mezerium200.
After one week the patient comes back to tell me that nothing has happened. No relief is there. Once again I investigated the symptoms. He explained that he has susceptiblity to cold and also had constipation for years. Here constipation is the main allied complication. I asked him to explain his constipation. He said he faces difficulties while passing stool whch is hard and dry. The anus is sore and there is slight swelling and sticking pain during and after stool. This time, I did not give any medicine related to his main complaint, but rather tried to treat the constipation with Aesculus Hip 1M(2d), followed by placebo for seven days. Aesculus Hip also has back pain with stiffness. After one week he showed some little improvement from his symptoms. I repeated Mezerium200(2d) followed by placebo for one week. After the week he said there was great relief of nightly pain. Now he can sleep at night. Suffering is there but less than before. Now the same medicine (Mezerium) begins to act when closely related allied abnormalities are treated and controlled. So I think that it is not always necessary to focus on the chief complaint of the patient.
One thing I found which is also necessary, is wiping out the effect of the previous medicines, even when a continuous process of chronic treatment is going on. This condition is often encountered while treating an obstinate type of arthritis. I was treating a lady aged 55 for her arthritic knees for almost one year. She was doing fine and progress was satisfactory. Then her pain, swelling and soreness increased severely. A uric acid and urea test revealed normal values. She complained of being feverish. Thirst was there, but for little and frequently. Temperature aggravation was midday and midnight. She was weak but restless and I thought of arsenicum album.. She had not done anything wrong which could aggravate the disease. I was confused about what to do and thought I was going to lose her case. Nothing was coming in mind. She was following every instruction. I thought to make a fresh beginning of the case. I gave her Nux Vom 200 (2d) with placebo for five days, with the option in my mind that I was going to take the case anew.
Now I started Arsenicum album 200(3d) with placebo. After a week there was a great relief. Pain and swelling was reduced by 50%. Fever was gone. I prescribed placebo for another week. I was thinking about what Nux did. It wiped out the medicinal effect of the previous medicines, though it is said Nux only antidotes medicines from the vegetable kingdom. But I have seen that Nux Vom200 antidotes the secondary action of every medicine. In several chronic cases where there was a continued treatment that became stuck, one needs a wiping of previous medicine effects. A fresh beginning makes the disease move forward.
The acute exacerbation of symptoms is often encountered. This must be controlled firmly and correctly or the case is lost. I have looked carefully into this acute aggravation of the symptoms. Almost 80% of these cases are due to bacterial or viral infection. What is more common is the common cold virus infection. When the patient is infected with this virus with body ache, fever and malaise, joint pain increases. When the infection is cured, all other symptoms are gone, but the joint pain remains.This virus mainly affects the synovial membrane, tendons and muscles surrounding the structure. X-Ray of the suddenly aggravated joints reveals no further bony abnormalities. X-ray shows only tissue swelling around the joint. I have been treating a 45years old man for the last eight months. He first came to me with polyarthritis. Every joint of his body was affected. Tearing pain was there with stiffness after rest. There was severe tearing pain from slight movement and aggravation at night. All metacarpal and metatarsal joints were swollen and stiff and sensitive to touch. I started his treatment with Actaea spicata 30, along with a few intercurrent and follow up medicines like Causticum, hypericum, ruta, symphytum, actaea rasemosa etc. His development was satisfactory. He was doing his salsman’s job very well, which was becoming difficult when he first came to me. He discontinued the treatment for one month. Viral fever was the main suffering when he came back after a month’s interval. All his joints were aching. It is difficult to distinguish whether it from the arthritis or because of viral infection. I made a plan. I decided to treat the fever first, then see if there is there is any relapse of the arthritis. When the fever was over, the sufferings allied with fever were gone. But the pain and swelling and stiffness of the joints remained. He was moving his joints but writhing in pain. The right shoulder joint was much more affected. It swelled and was sensitive to pressure. Previously he had the modalities of getting relief from moderate heat application. Now he said heat aggravates the pain. Previous medicines failed to response. I stopped all the medicines and prescribed Apis mellifica 200(5d) at 3 hour intervals with placebo for 3 days. His pain swelling and sensitiveness of joints were reduced by 80% when he came back after 5 days. I was also relaxed and happy that the crisis was over. Another 6 doses were required (B.D) to wipe out rest of the suffering.
It is not always necessary that we stick to the chronic treatment plan and wait for a long while before the chronic medicines starts the secondary action and the patient gets relief. Rather, we can give the patient relief and then can go back to the previously planned constitutional treatment.
If the knees are the parts involved by arthritis, the patient must follow one rule strictly. He must not bend the knee. This posture stretches and injures the shortened and fibrosed tendon. This only increases the pain and soreness. No medicine will be helpful if this practice is continued. Long walking is injurious to arthritic joints. But patients must walk 30 to 40 minutes every day in two divided slots. Otherwise muscles around joints becomes stiff and mobility decreases.
Cases where indicated medicines fail
In some cases there is frequent relapse of disease. What brings back the disease? Inherited miasm and infection are the causes. Staphylococcus aureus, nesseria gonorrhoea, are the causative organisms which cause infection to the synovial membrane and synovial fluid. Infection spreads to the joint through blood, infection from bone itself, infected places on the skin. All these are infections which cause or aggravate the arthritic condition.
In some cases I did blood tests which revealed that CRP is normal. There are some cases where in spite of staphylococcus infection, CRP remains normal. TSH was normal and urea was within normal limits. Only uric acid levels is sometime at the upper limit. In some cases CRP was elevated. I consider that these internal abnormalities be treated first. I stop all miasmatic medicines. The present aggravations and ameliorations are the main complaints I consider. The time of aggravation is also a main symptom in prescribing. Prescription from this aspect gives quick relief to the patient and the severe pathology of the disease is controlled.
Arthritis without complication responds rapidly to medicines, if the patient is not suffering from vitamin D3 deficiencies or Calcium deficiency. These plays an important role treating arthritis. I always give emphasis on correcting the deficiencies as well as stopping and controlling the last two conditions mentioned while treating arthritis. Correcting the diet depends on natural foods. Natural foods help much better in correcting these deficiencies, though in some severe deficiencies there remains no time for dietary compensation. An external supply of calcium and vitamins becomes evident. When the patient is advised dietary supplements, it is important that his digestive function and assimilation is normal. If not, you have to consider digestive treatment along with the main treatment. Calcarea carb and Calcarea phosphoricum in trituration helps much in supplementing the patient who has calcium deficiency.
I wanted to find out whether constitutional treatment gives relief to the patient’s suffering or a therapeutic approach acts earlier.
|Patient||Constitutional approach||Therapeutic approach||Remedies with follow up relation.||Management||day 1st||day 2nd||day 3rd||day 4th||day 5th||day 6th||day 7th||day 8th||day9th||day 10th|
|A||Apis mellifica200.3 hourly.(5d)||no||Arthritic management||pain begins to reduce.||Pain more less than 2nd day.||Effusion begins to reduce.||Effusion less again.||Effusion less.||Pain and effusion both are less.||Both less.||Both less.||Patient feels better by 50%.|
|B||Arsenicum album200(6d). 4 hourly.||Ferrum phosphoricum 6x.T.D.||Same||pain much less.||Inflammation slightly less.||Pain almost gone.||Inflammation much less.||Inflammation slightly remains.||Patient did not report.||Patient did not report.||Patient feels better by 50%.|
|C||Bellis perenis200(8d). 3 hourly||Helleborus N6||Same||Pain begins to less.||Pain less.||Pain less.||Pain less.||Drawing sensation begins to lessen.||Drawing sensation less by 60%.||Patient feels better. Pain absent.|
|D||Kali iod200(6d).3 hourly.||Actaea spicata200(4d)B.D.||Same||Pain begins to lessen from evening.||Pain less by 50%||Pain less by 80%||Pain gone. Soreness much less||Pain less again.||Soreness reducing.||Patient feels much relived.|
|E||Graphites200(2d)||placebo T.D||Same.||Pain begins to lessen.||Pain less.||Pain less. Soreness slight less.||Patient feels good by 30%.|
|F||Cal hypo.30(6d) T.D.||Placebo T.D.||Same||Pain begins to lessen.||Soreness less slight.||Pain and soreness less||Less.||Patient feels better by 40%.|
|G||Kalmia lat200(4d)B.D.||Placebo T.D.||Same||Pain begins to lessen.||Soreness begins to be less.||Patient feels better by 30%|
|H||Mezerium200(4d) B.D.||Placebo||Same||Pain begins to lessen.||Soreness slight less.||Patient feels better by 30%.|
I have seen clinically in treating for the last 10 years that Actaea spicata is complementary and follows Kali Iod very well. Actaea spicata also follows Graphites and Calcarea hypo.
While treating arthritis I always try to do a combination of therapeutic approach and constitutional approach. At the beginning, if the patient’s suffering becomes great and he is at the edge of his tolerance, I prefer to start with the therapeutic approach. When the torture of pain cools down, I start the constitutional approach. In absolutely every case, it stops the disease pathology and reduces sufferings quickly. The therapeutic approach makes the way smoother for the constitutional medicines. A disease, like arthritis which cannot be cured, should be treated with the intention that the pathology of the disease process must be held to where it is, and the sufferings of the patient reduced.