Abstract: A 23-year-old male reported the complaint of ganglion cyst on back of the left hand at the wrist joint with ulcers in mouth and hair fall. After analysing the case individualised homoeopathic medicine, Phosphorus, was prescribed which leads to improvement of symptoms. Homoeopathic treatment has shown favourable results in this case and demonstrates the scope of homoeopathy in such cases.
Keywords: Ganglion cyst, individualised homoeopathic treatment, RADAR (version 10.5.003).
Abbreviations: T.D.S. – thrice a day, cm – centimetre.
Introduction: Ganglion is a tense, cystic swelling and occurs due to myxomatous degeneration of the synovial sheath lining the joint or tendon sheath lining the joint or tendon sheath. They are common around joints because of abundant fibrous tissue. They contain gelatinous fluid (1). They are the most common soft tissue mass found within the hand and wrist, but they are also commonly encountered in the knee and foot. Although the majority of ganglion cysts are asymptomatic, patients may present with pain, tenderness, weakness, and dissatisfaction with cosmetic appearance. They can form at any age, they are most commonly found in women between the ages of 20 to 50. Women are three times more likely to develop a ganglion cyst than men. These cysts are also frequently encountered amongst gymnasts, likely secondary to repetitive trauma and stress of the wrist joint (2).
Case presentation: A 23 year old male reported with the complaint of recurrent round, small, painless lump (size 2 cm) on back of the left hand at the wrist joint since 6 months which is dissolves in 8-10 days automatically but now it present from 15 days. Patient also complaint of falling of hair especially from both sides of head since 1 month and small, red, painless, ulcers in mouth since 5 days. Took several allopathic medicines for ganglion cyst but no improvement could be observed. No significant information regarding family history.
Physical generals: Patient was tall, lean, thin, fair complexion, black hair. Thermal reaction of patient was chilly. He liked sweets and perspiration is scanty.
Mental generals: Patient’s memory is weak, easily forget things and always wants to be alone.
Diagnosis: The diagnosis is done on the basis of morphology of ganglion cysts. Ganglion cysts usually present as firm, well circumscribed, freely mobile masses approximately 1 cm to 3 cm in size. They are often fixed to deep tissue and not to the overlying skin (2).
Table 1: Analysis of symptoms
|Characteristic mental general symptoms||Characteristic physical general symptoms||Characteristic particular symptoms|
|Wants to be aloneWeak memory||Desire- SweetsPerspiration- Scanty||Lump (ganglion cyst) on back of the left hand at the wrist jointFalling of hair from both sides of headPainless ulcers in mouth|
Table 2: Evaluation and miasmatic analysis of symptoms(3)
|Wants to be alone||+++||Psora, syphlitic|
|Weak memory||+++||Psora, sycotic, syphilitic|
|Lump (ganglion cyst) on back of the left hand at the wrist joint||+++||Sycotic|
|Falling of hair from both sides of head||++||Psora|
|Painless ulcers in mouth||+||Psora, syphilitic|
Conversion of symptoms into rubrics: Reference from Synthesis 9.0 (English) Repertory by Frederick Schroyens using RADAR (version 10.5.003)(4) .
Table 3: Repertorial totality(4)
|Wants to be alone||Mind||COMPANY, aversion to|
|Weak memory||Mind||MEMORY, weakness of memory|
|Desire- Sweets||Generals||FOOD and DRINKS, sweets, desire|
|Perspiration- Scanty||Perspiration||SCANTY, sweat|
|Lump (ganglion cyst) on back of the left hand at the wrist joint||Extremities||GANGLION, Wrist, on|
|Falling of hair from both sides of head||Head||HAIR – falling – Sides|
|Painless ulcers in mouth||Mouth||ULCERS – painless|
Figure 1: Showing repertorisation chart
Justification of remedy: After taking a detailed case history and repertorisation, Phosphorus in 200C potency was given as homoeopathic individualised simillimum. After repertorisation and knowledge of materia medica, Phosphorus, Calcarea carbonica, Lachesis, Kalium carbonicum, Sepia officinalis were the most simillimum remedies. The reason behind selection of Phosphorus was that the patient was tall, lean, thin, so the constitution matches with Phosphorus (5) and thermal reaction was chilly (6). Kalium carbonicum and Calcarea carbonicum both patients are obese (7). Aversion for company present in this patient but in kali carb never wants to left alone (5). Lachesis mutus’s thermal reaction is hot but patient’s thermal reaction was chilly (6). Phosphorus covered more symptoms in comparison to Sepia officinalis. So, Phosphorus was selected. Overall improvement was noticed.
Prescription: Phosphorus 200C / 1 dose/ stat followed by placebo 30 / T.D.S/ 7 days was prescribed on first visit 7th march 2018 considering that the medicine was covering maximum repertorial totality, miasmatic background and physical general and mental general symptoms of the patient.
Table 4: Follow up
|14/03/ 2018||Ganglion cyst- no improvement, Ulcers – decreased, Hair fall – no improvement||Placebo 30 / T.D.S/ 7 days|
|22/03/ 2018||Ganglion cyst- slightly decreased, Ulcers – not present, Hair fall – no improvement||Placebo 30 / T.D.S/ 7 days|
|28/03/2018||Ganglion cyst- decreased, Ulcers – not present, Hair fall – slight improvement||Placebo 30 / T.D.S/ 7 days|
|04/04/2018||Ganglion cyst- decreased in size but not completely dissolve Ulcers- not present, Hair fall – improvement||Phosphorus 200/ 1 dose/ stat Placebo 30 / T.D.S/ 7 days|
|13/04/2018||Ganglion cyst- very much decreased, Ulcers- not present, Hair fall – improvement||Placebo 30 / T.D.S/ 7 days|
|21/04/2018||Ganglion cyst- not present, Ulcers- not present, Hair fall – significant improvement||Placebo 30 / T.D.S/ 7 days|
|28/04/2018||Ganglion cyst and ulcers – totally removed, No hair fall||Placebo 30 / T.D.S/ 7 days|
|05/05/2018||No complaints||Placebo 30 / T.D.S/ 7 days|
|11/05/2018||No complaints||Placebo 30 / T.D.S/ 7 days|
Discussion: The remedy Phosphorus has significant role on ganglion cyst. According to Boericke, Phosphorus should not be repeated too low or in too continuous dose (5), so in this case one dose stat was prescribed on first visit and repetition of single dose of Phosphors 200C after approximately 1 month. Patient is followed for a period of 2 months. The detail of follow up is given in table 4. Ganglion cyst slightly improved within first month, followed by overall improvement within 2 months.
Conclusion: Overall the case suggests the usefulness of homoeopathic medicines in the management of ganglion cyst. However, further research like RCT in multi-centric design is required on larger sample size before making firm recommendations.
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About the author
Dr Seema Gupta