Effectiveness Of Homoeopathic Treatment On Diabetic Foot Gangrene – An Evidence Based Case Study To Highlight The Practical Utility Of Richard Hughes Concepts In Clinical Practice

AUTHORS:

DR SHIVAPRASAD K. (HOD, PROFESSOR, DEPARTMENT OF ORGANON OF MEDICINE, FATHER MULLER

HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL- DERALAKATTE)

CO-AUTHOR:

DR DEEPA PAIS (ASSISTANT PROFESSOR, DEPARTMENT OF PATHOLOGY & MICROBIOLOGY FATHER MULLER HOMEOPATHIC MEDICAL COLLEGE & HOSPITAL MANGALORE)

DR ANANTHAKRISHNAN V A (PG SCHOLAR -MD – II DEPARTMENT OF ORGANON OF MEDICINE) FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL MANGALORE).

ABSTRACT:

BACKGROUND: This article tells us about effectiveness of Homoeopathy in the treatment of diabetic foot Gangrene, and also gives a treatment plan with evidence in proving the improvement in the quality of life the patient in detail. This case study highlights the practical utility of Richard Hughes concepts in Clinical Practice Methodology

METHODS: Specific totalities based on the different phase of the disease is analysed and appropriate totalities were constructed and applied accordingly using Richard Hughes concepts.

CONCLUSION: Helps us to understand the Process of homoeopathic treatment of a diabetic foot gangrene & how helpful Homoeopathic treatment is in enhancing the quality of life of such individuals suffering from gangrene as well as how homoeopathy avoids amputation of the whole foot as well as how it regulates auto amputation of affected toes naturally without any complications is demonstrated in the case study.

KEYWORDS: Miasm, Gangrene, Homeopathy Type 2 diabetes mellitus, diabetic foot ulcers, diabetic foot gangrene, peripheral vasculopathy.

INTRODUCTION

Type 2 diabetes is a life style disorder, if not treated can bring on man from ability to disability. One

of the major complications of type 2 DM is peripheral vasculopathy which in progress leads to

diabetic foot ulcers and gangrene ¹. Foot ulcers offers 15% life time risks for all diabetic patients ². The

estimated prevalence of DFU ranges from 4%-27% ³. In this article we will discuss a case of diabetic

foot gangrene which was progressing day by day and was successfully managed by homoeopathic

treatment. This article is also an evidence of how homoeopathy stops the progression of diabetic

gangrene and also how it promotes auto amputation setting aside all other complications.

Background of this case  Study speaks about the inception of Huges concept how it has undergone various modification in the treatment method and many other concepts according to the change had come during their time period  such as J. T. Kent, H.A. Roberts, Stuart Close, Dunham, Dudgeon etc., had their own methodology of Homoeopathic practice, these stalwarts rarely stood out of Hahnemannian concepts except one that is Richard Hughes.

PRELIMINARY DATA

Name: Mr. K

Age: 66 years

Sex: Male

Address: Kerala

Religion: Islam

Occupation: Cook

Marital status: Married

Date of Admission: 10/12/2019

PRESENTING COMPLAINTS

Patient complains of painful wound in the left foot since 6 months. There is also blackish discoloration of second & third toe of left leg. Amputation of his fourth & fifth toe of left leg was done before 6 days.

Location, Extension, Duration	Sensation & Pathology	A/F, Modalities	Accompaniments
Left foot (lateral aspect of base of big toe to base of 5th toe) Since 6 months Left foot 2nd & 3rd toe Since 3 days	Ulcer Offensive watery discharge Painful     Blackish discolouration       Pulling pain over plantar aspect of foot   Burning (occ)	<night <touch             <night <afternoon <pressure	Sleep : Disturbed due to pain Appetite : Decreased Thirst : Decreased

HISTORY OF PRESENTING COMPLAINTS

Before 6 months patient started with a painful wound in the base of 5^th toe of his left foot which then progressed and extended up to the base of big toe. He was under allopathic medication. Before 20 days due to severe pain he was admitted in hospital. Then on he developed with blackish discoloration of 4^th & 5^th toe. He then underwent amputation of his 4^th & 5^th toe of left leg before 6 days. Before 3 days he started on with blackish discoloration of 2^nd & 3^rd toes too. He took a voluntary discharge from the hospital following that. Presently he complains of pain and blackish discoloration of 2^nd & 3^rd toe with offensive watery discharge. He had chills & feverish feeling before 1 day.

There is no history of bleeding, redness, loss of sensation & weight loss.

Patient is known diabetic since 25yrs and is under allopathic medication.

PAST MEDICAL HISTORY

Childhood – chicken pox

PAST TREATMENT HISTORY

Allopathic medication for Ischemic Heart Disease

Known Hypertensive since 20 years

Known Diabetic since 25 years

PAST SURGICAL HISTORY

In 2010 – Bypass surgery

ALLERGIC HISTORY

Nothing significant

FAMILY HISTORY

Father – Hernia

Brother – DM

PERSONAL HISTORY

Diet – Mixed

Bowel habits – 1 time/day

Bladder habits – 4 to 5 times/day, no difficulty

Dreams – Nil

Perspiration – Decreased, partial on chest & underarms

Thermals – HOT

Addictions :- Cigarette smoking which started at his 20 years of age. He stopped it 2 months back

LIFE SPACE INVESTIGATIONS

Patient hailed from a low socioeconomic family, living with his parents, 1 elder brother, 1 younger brother and 1 younger sister. There was severe financial crisis for continuing his higher studies. So he started to work in small industries, hotels etc for his daily earnings. He got married at 32yrs of age.

During a medical fitness test conducted to apply for visa for going broad he was diagnosed with some cardiac troubles. He then tried some other ways to reach finally abroad where he was working as a cook.  Once when he was back in India, he got MI and had to do a bypass surgery.

As a person

• He is very stubborn in his decisions
• Doesn’t want to be a burden for anyone
• Wants to be perfect in time and work, he himself and others too
• Likes company

Since 1 month he is

• Highly irritable
• Restless
• Easily angered
• Wants to spend more time with himself
• Shouts at his wife & bystanders
• Doesn’t want to share about his feelings to others

GENERAL PHYSICAL EXAMINATION

Vital Signs :

BP : 140/70 mmHg

Pulse : 94/min

Respiratory rate : 22 bpm

Temperature : Afebrile at time of examination

ULCER EXAMINATION:

Blackish discoloration of 2^nd & 3^rd left toe (gangrenous appearance)

Ulcer after amputation of 4^th & 5^th toe of left leg

Number : 2

Size : 7cm × 8cm

Shape : oval

Offensive discharge

Thick, hard slough present

Tenderness : +++

Pulsations : present

Local rise of temperature : absent

SECTOR TOTALITY

• Gangrene of the toes
• Painful ulcer with offensive watery discharge; pain <night, touch
• Burning occasionally
• Sleep disturbed due to pain
• Appetite = decreased
• Thirst = decreased

REPRTORIAL TOTALITY (Synthesis repertory)

1. EXTREMITIES – Pain – Feet – Burning
2. SKIN – Gangrene
3. GANGRENE – Dry
4. GANGRENE – Old people
5. DIABETES MELLITUS- Gangrene

Secale cor = 11/5

Arsenicum alb = 8/4

Carbo veg = 5/3

Lachesis = 4/3

Mercurius = 4/3

FIRST PRESCRIPTION (11/12/2019)

Rx

     1. Secale Cor 30 (1-1-1)

     2. Syzigium Q (20-20-20)

      Cleaning & Dressing done with Echinacea Q dry

• Maintain Diabetic chart
• Maintain Diabetic diet
• Maintain Temperature Chart TDS

    19/12/2019 = Syphillinum 200/1P (EMES)

FOLLOW UP CRITERIA 

1. Appetite 
2. Thirst
3. Sleep
4. Pain in ulcer on left foot
5. Gangrenous discoloration
6. Offensive discharge
7. Feverish feeling
8. Chilliness
9. Itching
10. Dryness of skin
11. Pain in plantar aspect of foot
12. Headache

23/12/2019

1	2	3	4	5	6	7	8	9	10	11	12
G	G	G	P	S	S	A	A	S	S	P	A

New lesions appearing

Older ones are healing

Rx

1. Echinacea 6 (4 pills 2 hourly)
2. Mag Phos 6X (2-2-2)
3. Syzigium Q (20-20-20)
4. C & D with Echinacea Q dry

1/1/2020 = Syphillinum 200/1P EMES

6/1/2020

1	2	3	4	5	6	7	8	9	10	11	12
G	G	Disturbed	>	>	A	A	A	>	>	P	A

Rx

1. Echinacea 30 (1-1-1)
2. Mag Phos 6x (2-2-2)
3. Syzigium Q (20-20-20)
4. C & D with Echinacea Q dry

9/1/2020

1	2	3	4	5	6	7	8	9	10	11	12
G	G	Disturbed	<	>	A	A	A	>	>	>	A

Injury bleeding on slightest touch

Pus pockets present

Rx

1. Arnica 30 (4pills/2hrly)
2. Mag Phos 6x (2-2-2)
3. Syzigium Q (20-20-20)
4. C & D with Echinacea Q dry

18/1/2020

1	2	3	4	5	6	7	8	9	10	11	12
G	G	Disturbed	P	>	P	A	A	A	>	P	A

Stool = Hard, not passed since last 2 days

Rx

1. Staphysagria 30 (1-1-1)
2. Mag Phos 6x (2-2-2)
3. Syzigium Q (20-20-20)
4. C & D with Echinacea Q dry

23/1/2020

1	2	3	4	5	6	7	8	9	10	11	12
G	G	G	P	>	P	A	A	A	A	P	A

New lesions appearing

Rx

1. C & D with Gun Powder 6x
2. Staphysagria 30 (1-1-1)
3. Mag Phos 6x (2-2-2)
4. Syzigium Q (20-20-20)

31/1/2020

1	2	3	4	5	6	7	8	9	10	11	12
G	G	G	+	S	++	A	A	A	A	>	A

Rx

1. Secale cor 30 (1-1-1)
2. Mag Phos 6x (2-2-2)
3. Syzigium Q (20-20-20)
4. C & D with Gun Powder 6x

7/2/2020

1	2	3	4	5	6	7	8	9	10	11	12
G	G	G	+	P	++	A	A	A	A	p	A

Gangrene & ulcer persists

Offensive discharge +

Pain with burning +

O/E = dark discharge with offensiveness, slough formation seen

Rx

1. Anthracinum 30 (1-1-1)
2. Mag Phos 6x (2-2-2)
3. Syzigium Q (20-20-20)
4. C & D with Gun Powder 6X

22/2/2020 = Syphillinum 1M/1P HS

9/3/2020 = Syphillinum 1M/1P HS

21/3/2020

1	2	3	4	5	6	7	8	9	10	11	12
G	G	G	>	>	>	A	A	A	A	>	<

Headache : Right sided, bursting type of pain, extending from frontal region to right temporal region

Pain > by closing eyes, pressure

Rx :

1. Bryonia 30/ 1P stat
2. Bryonia 30/1P SOS
3. Other medicines continue

12/5/2020 = Syphillinum 1M/1P HS

16/5/2020 (DISCHARGE)

1	2	3	4	5	6	7	8	9	10	11	12
G	G	G	A	A	A	A	A	A	A	A	A

Rx

1. SL packet/8P once in 4 days HS
2. Mag phos 6X (2-2-2-2)
3. Syzigium Q (20-20-20)
4. 5gr tab (1-1-1)
5. Gun powder 6X external application

BEFORE TREATMENT, on admit (month of December)

MONTH OF JANUARY

MONTH OF MARCH

MONTH OF APRIL

AFTER TREATMENT, During discharge (month of may).

CONCLUSION:

This case shows the effectiveness of Homoeopathic treatment in avoiding the amputation of the diabetic foot gangrene as well as improving the quality of life of the patient. The concept of specific totality of Richard huges is used and the similimum to the totality as the requirement of the case was given to halt the progression of the disease and accelerate the susceptibility of the patient to react for the treatment by stimulating the Vital force

 As we all know that Richard Hughes criticized few concepts of Hahnemann and because of this he faced lot of criticism inside Homoeopathic world. He courageously said that we should be Homoeopathist not Hahnemannian and questioned existence and validity of Vital Force, Psora Theory and Drug dynamization. With all the oppositions he proved the usefulness of his theories. Richard Hughes put forward his views on Homoeopathy based on the development of other contemporary sciences. He concentrated more on pathogeneses and used lower potencies in his treatment. Thus, the same principles of Richard Huges were used to treat this case^4.

REFERENCE:

1. Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Davignon DR, Smith DG. A prospective study

of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study. Diabetes care. 1999 Jul

1;22(7):1036-42.

2. Fard AS, Esmaelzadeh M, Larijani B. Assessment and treatment of diabetic foot ulcer.

International journal of clinical practice. 2007 Nov;61(11):1931-8.

3. Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot

ulcer. World journal of diabetes. 2015 Feb 15;6(1):37.

4. cited on 20/08/2020