An Evidence - Based Case Report of Cholelithiasis - homeopathy360

An Evidence – Based Case Report of Cholelithiasis

MYTH or FACT? Individualised homoeopathy shows magic! An evidence-based case report of cholelithiasis.

ABSTRACT:

A four years old baby girl having diagnosed with cholelithiasis in USG came for homeopathic treatment with the hope to avoid surgical intervention. After complete case taking, case analysis and proper individualisation single homoeopathic medicine in single dose was prescribed. After four months of treatment, the patient not only got relief of her presenting symptoms but also a positive USG report gave result of no calculus in gall bladder. This article gives a clinically useful review of a case with evidence about how an individualised homoeopathic medicine treated gallstone successfully which increases the confidence level of a controversial mind that why and how one should apply homoeopathic medicine instead of doing surgery. The paper is intended to make readers aware of current thinking in this field.

KEYWORDS:

gallstones, individualisation, homoeopathy

ABBREVIATIONS:

right(rt), history of (H/O), acute gastro enteritis (AGE), ultrasonography (USG), once daily (OD)

INTRODUCTION:[1-2]

Gallstones are hardened deposits of the digestive fluid bile, that can form within the gallbladder. They vary in size and shape from as small as a grain of sand to as large as a golf ball.[1]Gallstones occur when there is an imbalance in the chemical constituents of bile that result in precipitation of one or more of the components. Gallstone disease is often thought to be a major affliction in modern society.[2]  In this particular case, the baby girl presented her clinical symptoms of pain abdomen with H/O AGE attack previously, occasionally occurrence of pyrexia was there with vomiting.

CASE STUDY

A 4-year old baby girl, with fair complexion, moderately-built presented with pain in abdomen around right hypochondrium.

She suffered from repeated AGE and hospitalised for the attack in last two years. She had H/O occasional pyrexia which came with constant yawning before the attack. She was passing hard stools in 2-3 days interval with constant offensive flatus. She presented with grinding of teeth at night in sleep. As per the narration of her parents, the girl was very obstinate, stubborn in nature.

Physical examination

  • The girl was restless and irritable while examining, was not allowing the physician to interact or check the pulse.
  • She was constantly pricking her nose while conversation.
  • She was not giving reply to physician’s query stubborn in nature.

Diagnosis

(1) This disorder is usually diagnosed by history of recurrent episodes of right-upper-quadrant or epigastric pain, suggesting biliary colic and Boassign. There may be fever, tender right upper quadrant with or without Murphy’s sign, tenderness when the hand taps the right costal arch (Ortner’s sign).[1]

(2) The three primary methods used to diagnose gallbladder disease are ultrasonography, nuclear scanning (cholescintigraphy), and oral cholecystography. Today, ultrasonography is the method most often used to detect cholelithiasis and cholecystitis. Occasionally, gallstones are diagnosed during plain x-rays. Ultrasonography has a specificity and sensitivity of 90-95%, and can detect stones as small as 2 mm in diameter.[2]

PATHOLOGICAL TEST:-

USG of whole abdomen- tiny calculus on gall bladder, cholelithiasis (Fig.1)

 Analysis and evaluation of symptoms

Fig.1

Mental generals Physical generals Particulars
     
Prefers company.Talking in sleep.Fear of dark or shadows. 4.Obstinate. Hot patient.Craving for eggs.Intolerance of milk and milk products. Stool hard.Passes offensive flatus.Grinding of teeth at night.Profuse perspiration on single parts, especially on scalp.

Totality of symptoms:

  1. Prefers company.
  2. Fear of dark.
  3. Talking in sleep.
  4. Obstinate.
  5. Hot patient.
  6. Craving for eggs.
  7. Intolerance of milk.
  8. Stool hard.
  9. Profuse perspiration on single parts.
  10. Flatus-offensive.
  11. Grinding of teeth at night.

Miasmatic analysis: The mental and physical characteristic symptoms are showing psoric dominancy so the case points towards psoric miasm. [3]  

Repertorisation (Hompath Zomeo) :

As the case was presented with prominent mental and physical general symptoms, Kent’s repertory was selected for repertorisation with help of Hompath Zomeo.[4]


 (Fig.2)

Treatment plan:

  • Individualised homoeopathic medicine with proper dose and potency by following homoeopathic law and principles. [5,6,7]

Prescription:-

1)CINA MARITIMA 200

     ONE  DOSE

2)PLACEBO 30 once a day for next four months till the baby was improving.

Patient was advised to avoid spicy, fatty foods and visit the physician once in every month for follow up.

Selection of dose and potency[5,6,7]

By considering susceptibility, seat of the disease and mentality of the child single dose of two hundred potency has been selected.[5,6,7]

Follow up:

Date Symptoms Prescription
27/02/2020 Chief complaints CINA MARITIMA 200 One  Dose
25/03/2020 Improved Placebo 30 for next 1 month
29/04/2020 More improvement than before Placebo 30 for next 2 month
20/06/2020 Gall stone disappeared CALCAREA CARBONICUM 200 One dose (prescription done as if the most simillimum antipsoric remedy for the purpose of individualised homoeopathic treatment for general improvement of health) [4](Fig.2)

Expected outcome of the treatment plan:-

Follow up of the case was scheduled to be done once in every month with the hope of –

 (1)Recovery of the patient by removal of the presenting complaints as well as restoration of the health with no further comeback of previous complaints.

  (2)Abdominal USG report with findings absence of gall stones.

ACTUAL OUTCOME:-

After four months of homeopathic treatment USG of whole abdomen was done with following follow up result.

Patient’s physical state:-

1)No abdominal complaints till now since the treatment started

2)No attack of AGE till now.

3)Baby was passing stools almost regularly.

4)appetite, thirst, sleep and all other generalities now had no imbalance.

5)USG(whole abdomen) report:-

Normal study with no calculus was found now.(Fig.3)

                                         Fig.3

CONCLUSION:  [3,4,9]

Gall bladder stone is quite uncommon in children but not rare for which patient always wishes to avoid surgical intervention. In the above described case, it is very clear that individualised simillimum remedy can give magical recovery. We know that smaller the dose of a truly indicated medicine, the better as it produces a gentle remedial effect.[3] Though through full analysis of the case as well as repertorisation CALCAREA CARBONICUM was indicating the most indicating remedy,[4] but on the basis of mental general, physician’s observation and symptoms similarity CINA MARITIMA was prescribed.[9] Then the follow up of the case with the anti-psoric (Calcarea carbonicum) was given where CINA MARITIMA  gave outstanding result with removal of the symptom. Even after 6months later, the patient gave no afterward complaints till date.

WHY INDIVIDUALISATION IS THE OPTION OF CHOICE?

It is described in §153 of Organon of Medicine, that it is the most striking, singular, uncommon, peculiar, or characteristic symptoms of the disease that are to be kept chiefly and most solely in view; it is for analogues to these that we must search through the lists of medicinal symptoms[8].

WHAT DOES SIMILLIMUM MEANS IN CASE PRESCRIPTION?

 The simillimum is the most similar remedy corresponding to a case, covering the true totality of the symptoms and always curative; also, in incurable cases, it is the best possible palliative remedy. The selection of the simillimum involves its administration singly and without admixture of any other medicinal substance. Alteration or rotation of remedies sometimes leads away from accurate and definite knowledge of drug effects, and sooner or later leads to polypharmacy which needs to be avoid in individualised homoeopathic prescription[6,7,8].

REMARKS:[6,7,8]

The homoeopathic dose, therefore, is always a sub-physiological or sub-pathogenetic dose; that is, a dose so small as not to produce pathogenetic symptoms; for we desire, not to produce more symptoms, but only to remove and obliterate symptoms already existing. It must also be given in a dose so small, as not to produce a severe aggravation of the already existing symptoms[6,7]. The success of homoeopathic treatment depends to a great extent on the correct selection of the potency and the requisite potency should be selected through the susceptibility of the patient[8].

REFERENCES:

1.Channa NA, Khand FD, Khand TU, Leghari MH, Memon AN. Analysis of human gallstone by fourier transform infrared (FTIR) Pak. J Med Sci. 2007;23:546–50.

2. Longmore M, Wilkinson I, Davidson E, Foulkes A, Mafi A. Oxford handbook of clinical medicine: Mini edition. 8th ed. London, England: Oxford University Press; 2011.

3.Roberts HA. The Principles and Art of Cure by Homoeopathy. New Delhi: B. Jain publishers (P) Ltd; 2013.

4.Hompath Zomeo – homeopathy software [Internet]. Hompath.com. Available from: https://hompath.com/zomeo.

5.Ganguly SN. Annotated Text of Hahnemann’s Organon of Medicine. 5th ed. Shahdara: Birla Publications PVT. LTD; 2007.

6.Close S. The Genius of Homoeopathy. New Delhi: B. Jain publishers (P) Ltd; 2004.

7.Dudgeon RE. Lectures on the Theory and Practice of Homeopathy. New Delhi: B. jain publishers (P) Ltd; 20198.

8.Dey SP. Essentials of principles and practice of homoeopathy. 4th ed. Kolkata: Published by Smt. A Bhattacharya; 2009.

9.Kent JT. Lesser Writings. New Delhi: B. jain publishers (P) Ltd; 2004.

ABOUT THE AUTHORS:

Dr Navin Kumar Singh[1], Dr Biswajit Bera[2], Dr Tamara Afroza[3]

[1] Lecturer, Dept. of Case taking and Repertory, The Calcutta Homoeopathic Medical College and Hospital.

[2] Currently pursuing MD, Hom. (Part-II) in Practice of Medicine from The Calcutta Homoeopathic Medical College and Hospital. B.H.M.S (Honours) from The Calcutta Homoeopathic Medical College and Hospital. Kolkata, WB.

[3] Currently pursuing MD, Hom. (Part – II) in Practice of Medicine from The Calcutta Homoeopathic Medical College and Hospital. B.H.M.S. (Honours) from D.N.DE Homoeopathic Medical College and Hospital. Kolkata, WB.

Homeopathy360 Team
Posted By: Homeopathy360 Team