Homoeopathic Management In A Case Of Arterial Ulcer
ABSTRACT: A case of Arterial Ulcer treated Homeopathically with Anti -miasmatic medicine based on symptom similarity.
KEY WORDS: Arterial Ulcer, Homoeopathic medicine, Antimiasmatic.
Abbreviation: += Present, G=Good, = amelioration, s=same, D=decreased, A=Absent.
INTRODUCTION:
Arterial ulcers, also referred to as ischemic ulcers, are caused by poor perfusion (delivery of nutrient-rich blood) to the lower extremities. The overlying skin and tissues are then deprived of oxygen, killing these tissues and causing the area to form an open wound.
EPIDEMOLOGY:
Chronic leg ulcer (Arterial Ulcer) is defined as a defect in the skin below the level of knee persisting for more than six weeks and shows no tendency to heal after three or more months. Chronic ulceration of the lower legs is a relatively common condition amongst adults, one that causes pain and social distress. The condition affects 1% of the adult population and 3.6% of people older than 65 years. If not taken care of in time, there are very high chances that these may become infected and eventually may have to be amputated. Individuals with history of previous ulcerations are 36 times more likely to develop another ulcer.
Chronic leg ulcers aect .–% of those aged over years,
increasing to over % of those aged over years.
Chronic leg ulcers aect .–% of those aged over years,
increasing to over % of those aged over years
Predisposing factors:
The most common cause of arterial ulcers is atherosclerosis. Risk factors for the development of atherosclerosis include age, smoking, diabetes mellitus, hypertension, dyslipidemia, family history, obesity, and sedentary lifestyle.
Clinical features:
Arterial ulcers are characterized by a punched-out look, usually round in shape, with well-defined, even wound margins.
Location: found between or on the tips of the toes, on the heels, on the outer ankle, or where there is pressure from walking or footwear.
The base of the wound typically does not bleed, and is yellow, brown, grey or black in color.
Sourrounding Area: Often the limb will feel cool or cold to the touch, and the extremity will have little to no distinguishable pulse. The skin and the nails on the extremity will also appear atrophic, with hair loss on the affected extremity, while also taking on a shiny, thin, dry, and taut appearance.
These ulcers are generally very painful, especially while exercising, at rest, or during the night. Arterial ulcers are distinguishable from venous ulcers in that venous ulcers present with redness and edema (swelling) at the site of the ulcer, and may be painless.
CASE HISTORY:
A 56-year-old male presented with complaints of wound on bilateral ankle. lateral aspect , with burning pain. Itching. serous discharge (non offensive, no bleeding) Complaints started since 2 years and more from 3-4 months. His complaints started with itching, after a thorn prick followed with burning sensations at night. Itching increases by scratching, later formed wound. Patient has taken Allopathic medication for the same since the onset of the complaint. Known case of Diabetes Mellitus since 10 years (Stopped Allopathic Medication)
Past History:
Nothing significant
Family History: Hypertension-Mother
Treatment History: Taken Allopathic medication for presenting complaint.
PATIENT AS A PERSON:
Appearance: Obese
Appetite: Good
Thirst: less (5-6 glasses per day)
Desire: meat2+
Aversion: vegetables
Habits: Bidi- 10 years back occasionally
Bowel Habit: once /day, (constipation occasionally).
Bladder Habit: 4-5 times /day and 1-2 times at night.
Sleep: Disturbed due to burning pain (11 PM to 6 AM)
Thermal: chilly patient
Dreams: unremembered
Life space investigation:
Patient hails from a Low socioeconomic family. Had apparently an unpleasant, childhood. He was not sent to school and started kooli work at a very young age. He has 3 elder and 5 younger siblings. He was attached to mother. His siblings use to insult him and was thrown out of house, and he never got married. From childhood he is irritable and gets anger but now he doesn’t expose his anger, suppress his emotions.
General physical Examination:
Well-built and moderately nourished
Well oriented with time, place and person.
No signs of pallor, cyanosis, clubbing, icterus and lymphadenopathy
Vital signs:
Temperature: afebrile at the time of examination.
Pulse: 87 beats /min
Blood pressure: 130/80mmhg
Local examination:
Bilateral Ankles: Lateral Malleolus.
Inspection:
Wound on both ankles
Oval Shape, Irregular Margins, punched out edges
Serous Discharge (non offensive), Granulation present, Slough present
Surrounding area blackish discolouration, no varicosities.
Palpation:
Tenderness present, Base movable, deeper structures muscle felt
No contact bleeding, peripheral pulses not felt prominently, no local rise of temperature.
Size: Right- 7.4cm×6.5cm×1.4cm
Left- 8cm×6cm×1.2cm
Systemic Examination:
Respiratory system:
Normal vesicular breadth sounds
No added sounds
Cardiovascular system:
S1 and S2 heard.
No murmur
Diagnosis
Arterial Ulcer
MANAGEMENT:
General management
Diabetic Diet
Fatty food to be minimized
Drink lot of water
Eat vitamin c rich foods like orange, lemon and gooseberries
Ancillary measures
Avoid using tight shoes.
Maintain hygiene and clean area using septic measures
Dry Dressing Alternate days with echinacea tincture.
Homoeopathic management:
Sector totality:
Ulcer bilateral leg ankles
Burning sensation+
Burning-night
Burning cold+
Itching 2+
Serous discharge from wound
Prescription
31/ 10/2020
1. Echinacea 6c
BD
2. Calc Sulph 6X -10 days
Dry Dressing Alternate days with echinacea tincture.
Follow up criteria
1. Sleep
2. Bowels
3. Itching
4. Burning
5. Discharge
Abbreviations: + = Present, G=Good, > = amelioration, s=same, <=aggravation, A=Absent.
Follow ups
11 /11/2020
1 2 3 4 5
S G S + >
Prescription
1. Nitric acid 30
1TSP HS
2. 5 grain Tab BD
3. SL (sos -for burning) – 2 weeks
Dry Dressing Alternate days with echinacea tincture and calendula dusting powder
3 /12 /2020
1 2 3 4 5
G G > > >
Prescription
1. Nitric acid 30
1TSP HS
2. 5 grain Tab BD – 2 weeks
Dry Dressing once in 3 days with echinacea tincture
18 /12 /2020
1 2 3 4 5
G G > > >
Prescription
1. Nitric acid 30
1TSP HS
2. 5 grain Tab BD – 2 weeks
Dry Dressing once in 4 days with echinacea tincture
2 /1 /2021
1 2 3 4 5
G G > > >
Prescription
1. Nitric acid 200
1TSP HS
2. 5 grain Tab BD – 2 weeks
As the patient has used allopathic external application for the presenting complaint his disease is suppressed and clear picture of the disease was not available, so sector totality was taken and based on symptom similarity medicine was prescribed.
CONCLUSION:
Patient named Mrs E had wound on bilateral leg with burning pain sensation, itching and serous discharge. The case was diagnosed as Arterial ulcer. Nitiric acid 30 and later 200 was prescribed as Anti- Miasmatic remedy, Patient completely recovered.
REFERENCES:
1. Davidson’s Principles and Practice of Medicine: a textbook for students and doctors. ELBS with Churchill Livingstone; 1991 Sep 20.
2. HOMOEOPATHIC MATERIA MEDICA – William Boericke
3. Clinical Materia Medica – EA Farrington
4. THE CHRONIC DISEASES Their peculiar nature and Their Homoeopathic cure – Samuel Hahnemann.
About Author:
Dr.Ranjan Clement Britto BHMS MD
Associate Professor, Department of Organon of Medicine
Father Muller Homoeopathic Medical College
Deralakatte ,Mangaluru 575018
Co-Author: Dr.Febin George
PG Scholar, Department of Organon of Medicine
Father Muller Homoeopathic Medical College
Deralakatte Mangaluru 575018
