Abstract: Diseases pertaining to vital organs have always been a subject of special interest and research. The conventional system of medicine, since the past few decades has realized that these cases need an integral approach. The field of renal medicine has also witnessed an era of revolutionized methods, both in terms of diagnostics and therapeutics. Presently on one hand, we have a variety of advanced means to assess the functional capacity of kidneys through Renal Function Tests, and on the other hand we have wonderful imaging techniques like USG, CT, MRI, Pyelography, Intravenous urography, Renal arterio- & veno-graphy etc. Apart from this, we are also equipped with modern techniques for replacement of renal function, by Peritoneal Dialysis & Haemo-dialysis, in cases of acute & chronic renal failure!
Now as far as the therapeutics of nephrological diseases is concerned, the Allopathic school proudly acclaims its ‘latest’ specific medicines, ranging from their all-time favorite antibiotics to NSAIDs. But at the same time, they frankly admit the potential toxic effects of these drugs on human economy.
Hence it is apparent, that in-spite of constantly renewing and renovating the chemical composition of their medicines, the old school is still stagnant in terms of their methods of employment. Just as the contemporaries of Dr Hahnemann, the present day allopathic physicians focus on the disease ultimate and recognize the resultant pathological findings as the sole object of treatment!
I do not intend to discuss the fallacies of conventional system. This is NOT our mission, which Dr Hahnemann wants us to accomplish. But the present state of affairs compels me to ponder over certain facts. It is undoubtedly true that Homeopathy proves its excellence, provided its scope & limitations are strictly kept in mind! It rests on the transcendental trinity of ‘similia, simplex & minimum’, of which our therapeutic principle is a scientific derivation, application & confirmation.
I feel that it is a matter of introspection that can be framed into 2 basic questions:
First: How do homeopathic principles direct us to proceed in every case of sickness?
Second: What, we homeopathic physicians do in our clinical practice, i.e. to what extent do we work in accordance with the Law of cure? These queries become even more applicable in diseases bearing a specific nosological / diagnostic name.
This paper is an attempt to discuss the practical utility of Homeopathy in various diseases of urinary tract.
The success of homeopathic treatment in renal diseases depends on the following facts that have to be seriously considered, prior to deciding further course of action.
1) Nature, context & severity of subjective + objective manifestations.
2) Stage & extent of organic pathology.
3) Degree of functional impairment as witnessed by blood & urine bio-chemistry.
4) Severity of systemic manifestations secondary to kidney diseases, for eg. Hypertension, oedema etc.
5) Lastly but most importantly from homeopathic point of view, analysis & evaluation of above findings in order to frame the ‘totality’ of the case, thereby making an assessment that what role can be expected from homeopathy in the same. In other words, we should be able to define- what is curable in the case under examination! Remember that our medicines can only cure what they have produced during proving!
Now at first instance, these pre-requisites would seem quite apparent & well known to all of us, but unfortunately, they are casually overlooked in practice and every case is hastily claimed to be under the scope of homeopathy! These high promises are pitifully based on one- sided view of the case and a spineless knowledge of Materia- Medica & Organon of Medicine. Hence, very often the so called ‘popular organ remedies’, are tried with prejudiced mindset. Who amongst us is not aware of famous ‘Berberis Q’ prescription, in ALL cases of renal calculi?
The result is purely at the disposal of destiny because if one were lucky (i.e if by chance, the medicine & dosage were homeopathic to the case), then the ‘routine’ medicine would win the battle and the physician shall proudly display the success. But if the result is otherwise, the physician will flatter his conscience by labeling this as a failure of system. To make matters worse, the patient who has been robbed of his health & wealth, will leave no stone un-turned in defaming homeopathy!
Hence it is crucially important, that besides being confident of our strengths, we should be well aware of our limitations. Though our therapeutic principle, is universally true in itself, yet it should also be acknowledged that like all Natural laws, it too is dependent on certain conditions that govern its applicability at different times & in different situations.
1) Significance of Pathological Diagnosis & Special investigations in defining the role of Homeopathy.
Knowledge of Physician has an essential element namely knowledge of disease. Though it is true that in homeopathy we neither have specific medication for a given pathological condition, nor do we consider disease to be a mere collection of tangible phenomena, yet these manifestations pertaining to a part or organ, which we call Particulars, are of inestimable value as regards diagnosis, pathological staging, prognosis & management. They can even decide the choice of one or other mode of treatment. It is for us to be keenly vigilant to assess the gravity of these particulars & proceed accordingly. One should never be impatient to administer homeopathic medicine in every case! For eg. In a patient presenting the chief complaint of passing ‘red urine’, it would be unscientific to straightaway give Lycopodium on superficial reportorial study! In such cases it would be methodological to bear in mind all possible causes of Haematuria ( lesions of urinary tract like glomerulo-nephritis, tubulo-interstitial diseases, renal adenocarcinoma, polycystic kidneys, renal tuberculosis, renal calculus, cystitis, prostatic hypertrophy or carcinoma, urethritis etc. Some extra renal causes lying within pelvis, might be responsible eg. Ca rectum, Ca cervix, pelvic abscess etc. Similarly general bleeding disorders, collagen diseases & right sided heart failure have also to be considered).
Now the exact source of haematuria, can only be traced by laboratory investigations & imaging techniques. Besides this, the associated symptoms will also aid in deciding the diagnosis.
Once this is done, it shall be very beneficial in defining the role of homeopathy in that particular case! A substantial knowledge of Organon & philosophy will make it clear that whether this case comes within our scope & what kind of treatment (curative or palliative) can be offered.
It is definitely true that the homeopathic prescription will not be much influenced by the NAME of disease, but the latter has 2 utilities.
First- The nature & intensity of pathological process helps us to diagnose the Active Miasm, for eg, a case presenting severe fluid retention, hypo-proteinaemia & other signs of renal insufficiency accompanied with profound depression of vitality, within a short period, points towards an acute miasm or an acute flare up of syphlitic/ sycotic miasm! Similarly, a case of pure inflammatory origin depicts Psora, a case showing degenerative phenomena like pyuria, severe proteinuria & urinary casts as in tubular necrosis, shows active syphilis, severe haematuria shows tubercular miasm, urinary calculi, gross structural hypertrophy & malignancy denotes active sycosis or Cancer miasm! This helps us in selecting the appropriate anti-miasmatic remedy.
Second- The stage & extent of pathology helps us to understand that whether the case is in the domain of surgery or therapeutics. In latter instance, it helps in finalizing the choice between acute or chronic constitutional prescribing as well as the suitable potency. It is very crucial to perceive the type of pathology because otherwise we shall make the fatal mistake to prescribe for ‘irreversible end-products’ of disease. This cannot be sufficiently stressed upon, as I have heard of many physicians promising ‘cures’ in cases of well- advanced renal cancers & all cases of kidney stones irrespective of their size & position. The statement from Dr. Stuart Close, in Genius of Homeopathy, clarifies it further— “ While gross pathological tissue changes, organic lesions, morphological disproportions, neoplasms and the physical effects of mechanical causes are not primarily within the domain of Similia, and therefore not the object of homeopathic treatment, the morbid processes from which they arise are amenable to hom. medication.”.
2) Case Taking & Framing the Prescribing Totality by selecting the individualizing PQRS complex. (discussed in 2 parts, A & B)
In renal diseases, like any other case, this process involves ascertaining the totality of signs & symptoms, a complete account of all the sufferings as described by the patient himself, his attendants, things perceived by the doctor himself and findings of special investigations.
Here we have to adopt 2 different approaches in accordance with the fact that whether, the case at the time of consultation demands an acute medicine or chronic constitutional treatment. This will solely depend on the severity & violence of the chief complaints causing distress to the patient!!
A) Acute Renal manifestations
In cases with acute distress, for eg. In Renal, vesical or ureteric colic, strangury etc, first of all it is necessary to relieve the patient of his sufferings. Moreover the physician should also recognize the need of auxiliary measures, hospitalization, surgical or mechanical intervention etc. In a case of acute retention with intense supra-pubic discomfort and threatening shock, it is of prime importance to mechanically evacuate the bladder by catheterization!
At this point, it would be suitable to quote Dr. Stuart Close— “ Circumstances sometimes arise when the strongest man & ablest prescriber, by reason of the great moral pressure brought to bear upon him, by the peculiarities of his patient, of the environment, or from lack of time, will be compelled to tide over a period of unendurable suffering by use of analgesics, or some other measure to meet extra-ordinary emergencies. He does this as a charitable concession to the weakness of human nature_ _ _ _, But time & circumstances are at least sometimes beyond his control. It is possible to violate the spirit by adhering too closely to the letter of law. Victory is sometimes gained be appearing to yield, which is quite in accord with the principle of Similia, a sort of moral homeopathy”.
In acute emergencies, homeopathic medicines can act as quickly and sometimes even more efficiently as compared to other therapeutic systems, provided the correct medicine is administered in correct potency. To ensure the correctness of our selection, no prejudices should be kept and the physician should carefully comprehend the language of nature as it is.
Every possible effort is to be made, to investigate the presenting most troublesome symptom in terms of location, causation (i.e. exciting cause, NWS etc), sensation, radiation, modalities & concomitants. Once we have a complete symptom with its individualizing characteristics, we can confidently select the most similar medicine & administer it in the potency corresponding to the susceptibility of the patient at that given time. Usually the 200th & higher potencies prove their worth in such cases, provided the patient has enough vitality to bear their impact!!
Dr. H. Roberts, in his ‘Principles & Art of Cure by Homeopathy’, encourages us as follows—“The homeopathic physician recognizes an important principle in these serious states; the more acute the case, the more the infection strikes at the life of the patient, the more clearly indicative are the symptoms. The similar medicine works regardless of the name of disease towards a true & complete cure, without sequeale or constitutional involvement”.
B) Chronic Prescribing in Patients with Renal diseases
Here we are to proceed, as in any other case, and we should not allow ourselves, getting biased by the pathological diagnosis. We should not dwell as a priori, on the medicines having a ‘well known reputation’ in apparently similar cases, for eg. the famous kidney remedies. Our aim is to attain the true potrait of sickness in its entirety, and for this we need much more information related to the patient. It is at this point where the pathological data & particulars often prove to be insufficient.
- First of all we should have a record of all the presenting complaints in their completeness, with special attention to duration, mode of onset, modalities & concomitant features of each individual symptom.
- Then the details concerning the Past Medical History and Family History are to be collected. The history of the treatment been taken by the patient till date, is also to be noted.
History of vaccinations, surgeries and accidents should be enquired.
- Now the most significant turn comes where the interrogation is to be made as regards Physical generals & Mental generals, which though apparently seem to be unrelated to the case, yet they serve as the backbone of homeopathic prescribing!!
- Regarding physical generals, we need to enquire about various facts such as Appetite, thirst, stool, urine, sweat , sleep, thermal reactions, conditions of aggravation and amelioration with respect to time, position, weather etc etc. Food cravings, desires, aversions & aggravations are important. In case of females, the menstrual history And the general condition of the patient in relation to the periods is to be noted.
- In case of mental symptoms, one should investigate the life situation of the patient with type of response. Emotional characteristics are very difficult to be elicited by direct questioning, hence the physician has to be tactful in approach & keen in perception to record them. Anger, loves, hates, anxieties, fears, phobias, irritability, relationship to loved ones, personal preferences concerning company or solitude, apathy, general mood, self confidence etc, furnish as valuable features. Dreams, too deserve attention. The mental faculties of the patient can be investigated by recording peculiarities related to intellect, memory, delusions, concentration powers, and comprehension abiliti
A very important technique which should be used in all homeopathic cases is that of under lining. For any given symptom, there are three factors that determine its emphasis—clarity, intensity & spontaneity. Each symptom should be correctly evaluated and analysed in order to make it as a basis of prescription. Vague & indefinite totality, always leads to haphazard repertorisation. There should be no prejudice towards any class of symptoms for eg. it is true that mentals form the most important part of totality, but a common mental that is ill defined & uncertain, is useless. No rigid boundaries are to be laid during case analysis, even a particular that is complete & peculiar, can serve as a reliable basis of remedy selection! Never try to carve a case, just accept it as it is, and proceed
1) Vithoulkas George, Science of Homeopathy. Chapter- Taking the case.
2) Close Stuart, Genius of Homeopathy. Chapter- Scope of Homeopathy.
3) Roberts Herbert, Principles & Art of Cure by Homeopathy. Chapter- Modern medication & Homeopathic Principles.