Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder characterized by irregular menses, hyperandrogenism, and polycystic ovaries. Lifestyle modification is a first‐line intervention. Existing information indicates a positive role of homoeopathy but more rigorous studies are desirable. This Prospective study shows that importance of homoeopathic medicine in PCOS using the concomitant symptoms during menses. Boenninghausen was the first to realise the importance of the concomitants in prescribing and constructed his repertory. Concomitant symptoms are based on the inherent constitutional differences and tend to remain constant with a patient, irrespective of the nature of the disease. A sample of ten cases of PCOS has been treated with concomitant symptoms covering constitutional homoeopathic medicine for a year with regular follow up. Cases are collected from the OPD of Sarada Krishna Homoeopathic Medical College, Kulasekharam. This study is further focused on psychological burden of individuals and how they evolved as psychosomatisation and personality adaptation in the development of PCOS. The data is collected by the art of case taking.
PCOS, concomitant, constitution, psychosomatisation, personality adaptation, and case taking.
PCOS: polycystic ovarian syndrome
CVD: cardiovascular disease
C-S: co-ordinate systems
OPD – outpatient department
Polycystic ovary syndrome (PCOS) was first reported in modern medical literature by Stein and Leventhal who, in 1935(1) .The disorder can be morphological (polycystic ovaries) or predominantly biochemical (hyperandrogenemia). Hyperandrogenism, a clinical hallmark of PCOS, can cause inhibition of follicular development, micro cysts in the ovaries, anovulation, and menstrual changes(2)It is now recognised as a common, heterogeneous, heritable disorder affecting women throughout their lifetime(1).They may be at increased risk of multiple morbidities, including obesity, insulin resistance, type II diabetes mellitus, cardiovascular disease (CVD), infertility, and psychological disorders(3). Previous studies in Euro-American populations have shown that women with polycystic ovarian syndrome (PCOS) have increased levels of “psychological burden”(4).The diagnosis of PCOS is based on Rotterdam criteria.
As a part of homoeopathic management, this study is given importance to concomitant covering the constitution remedies. This study is given more importance to concomitant symptoms as proposed by Boenninghausen. Concomitant symptoms are based on the inherent constitutional differences and tend to remain constant with a patient, irrespective of the nature of the disease. (5) Among that concomitant symptoms of MENSTRUATION are given more importance such as
- Before menstruation
- At the beginning of menstruation.
- During menstruation.
- After menstruation.(6)
This study is to define the importance of concomitant symptoms during menstruation and their role in psychosomatisation, personality adaptation, and covering the constitutional remedies.
The main aim of the study was to understand the importance of concomitants during menstruation, psychosomatisation and personality adaptation
MATERIALS AND METHODS
Ten cases of PCOS have been treated with homoeopathic medicines had taken up for the study. Cases are collected from the OPD from our Sarada Krishna Homoeopathic Medical College. Female of 11-40 years of age are included in this study. The remedies have been prescribed on the basis of symptom similarity and on the basis of concomitant and constitutional totality. Collection of standardised case record data of 10 cured cases in which acute, chronic, and intercurrent remedies has been used for the treatment of PCOS. The case has been studied on the basis of case concept form. The problem of the patient has been defined by interview technique and the data’s have been recorded in clinical record. The collected data’s have been organised, processed and connected each other through:
- Symptomatic classification and evaluation
- Hahnemannian miasmatic pathology – current interpretation
After that the data’s have been analysed and synthesised through acute totalities, chronic totalities and intercurrent totalities. Totalities have been obtained through reportorial and non – repertorial techniques. All these obtained concepts are presented totally as problem structuralisation; here several concepts will come into play. The structuralised concepts help to resolve the problem of a patient through remedial as well as non – remedial such as general- individual, general- environmental, mechanical measures and ancillary measures. These total definition of the case helps to treat the patient through specific homoeopathic planning and programming. Concept of posology, remedy response and subsequent actions are taken into consideration. The improvement is assessed through the concepts of palliation, cure, suppression and the prognosis of the case has been obtained.
- In this study age group between 11 to 40 years of female are considered among that, study showed 11 to 30 years of age women had PCOS. Most of them are students, working women and house wives. Among this, study showed the clinical features such as amenorrhoea, hirsutism, acanthosis nigricans, back pain, leucorrhoea, menorrhagia, itching and burning in genital, lump in breast, irregular menses. All of them had mental emotional state as well as disposition. Most of the females had particular, mental, as well as both mental and physical as concomitants respectively. Most of the cases developed psychosomatisation gradually from childhood. Study reveals that, more intraperson conflict and interpersonal conflicts contributes to the development of PCOS. Constitutional remedies such as NATRUM MURIATICUM, LACHESIS MUTUS, KALIUM CARBONICUM, PLATINUM METALLICUM, TUBERCULINUM, SEPIA AND SILICEA TERRA was useful to treat PCOS constitutionally and most of the case had given counselling to maintain proper healing.
In this study, all the ten cases are selected randomly from the OPD of Sarada Krishna Homoeopathic medical college, Kulasekharam. The females of age group between 11-40 years were selected. The high prevalence of PCOS is commonly seen in young females who follow modern lifestyle. In PCOS, stress plays the major role and effects of stress producing the psychosomatisation, considering this the topic was selected and also to find out the importance of concomitant during menstruation.
Usually age of 15 to 32 years female started to play various phases in their life like responsible daughter, friend, and wife. The peak age of reproductive life too begins here. When they have emotional and behaviour disturbance, their hormones show mild to maximum variation, as it is one of the triggering or main causes of PCOS.
In the western life style students undergoing many phases as mentioned in age, mechanical aided games, school, college, and disappointment are some of the reason for increasing the stress. Some of house wives had PCOS, because they were not engaged on any other works other than household work. Housewives are mostly alone in home at daytime.so they think about the previous bitter events. But according to modern lifestyle it has been changed.
In this study, Rotterdam criteria: include oligo-ovulation and/or anovulation, Excess androgen activity, polycystic ovaries (by gynaecologic ultrasound)(7). This study suggests that most of the patient presented with irregular menses with minimal functional level symptomatology and pathology.
In homoeopathic disease evolution that Dr M.L Dhawale has discussed, psora, the sympathetic, became overactive due that ovarian imbalance leads to functional menstrual disorder. Acrid non-infective leucorrhoea with emotional background is a psoric expression. When reduce sympathetic activity and over stimulation with resultant slowing down of activity, processes, faculties and functions, accelerated by increasing activity of the para sympathetic. The system goes into a state of exhaustion. The psoric patient slips into sycosis(8).
From this study, emotional symptom become more prominent, emotion plays major role for the development of psychosomatisation from suppressed and repressed emotion. Mental symptoms are classified into mental emotion, intelligent and behaviour emotion, and intelligent.
Dr M.L. Dhawale explained about classification of mental symptoms, emotion plays a significant part in the livers of most of the individuals, hence the mental state open with this section. The primary emotions of anger-sadness, love-hate and fear-anxiety are given prominence. The secondary emotion like suspicious, jealousy, etc. gets attached to those dominant emotions where they arise as an offshoot. Intellectual state comprises of the complex of primary faculties (consciousness, thinking, memory), the derivations (perception and decision making) and the resultants of the emotional and the intellectual functioning (judgement, confidence, person, etc.), action (speech and behaviour) and functioning (autonomic functions, sleep and systems functioning). There is also a final conclusion as to the nature of the total result in terms of the balance achieved(9).
Dr M.L. Dhawale has also mentioned about time -dimension concept and expression among that included time-change, periodicity, evolution, causation, concomitance, velocity, direction, and eternity. Any phenomenon in nature evolves in a field and expresses itself in various co-ordinate systems (c-S). It is possible for an external observer to single out any one of the many C-S as the main one and analyse it from the sequential point of view (causation). The other C-S evolve concomitantly with the main C-S but we are unable to detect a sequential relationship between these. These therefore fall outside our concept of causality. All the same, these can be utilised by the external observer of the phenomenon as essential identifying (as well as differential) characteristics of the phenomenon in question. Concomitant co-ordinate series thus give us another equally important dimension of the expression of time(10).
The concomitant bear no other relationship to the chief complaint than this time association. The study suggests that concomitant symptom present in three forms mental, physical and particular.
Psychosomatisation happens where the person emotion becomes imbalance and their inner core fails to express. Thus, the body express it in the form of psychosomatisation. From this reveals PCOS is the psychosomatic disorder rather than mentioning it as disease.
This was explained by Dr Dhawale, in Evolution and Expression of mental symptoms, He says that, the mental symptoms which forms the most important core of homoeopathic prescribing always are an expression of the continued conflict: the conflict that is between higher and lower animal instincts; between the higher values and the blind consummation of our desires; between the spirit that guides the substance towards higher values, images and ideas and infantile egoism and egotism that erode as well as corrode all values, finally dragging the organism downward to self-destruction. The transcendence of the soul is thus prevented by the substance, and the conflict produced leads to anguish which is expressed peripherally as mental symptoms(11).
For the peaceful life, person knows to follow the balance inter and intra personal relation, when in the inner core arises the conflict, the person has to suffer from the personality adaptation. It was expressed as physical or body level in physical it expressed as craving and aversion, sexual sphere and in body level it was expressed as symptoms. PCOS is one of the psychosomatic disorders with relation to inter and intra personal relation.
This was explained by Dr Dhawale, in evolution and expression of mental symptoms, He says that a patient needs to examine the patient’s interpersonal relationships from childhood onwards with reference to his wishes, ambitions and vocations. He can then know the affections, hatreds, resentments, vexation, humiliation, indignation, fear, conscience, disillusion, etc. which the patient experienced. His emotional nature must be understood from the stand of point of externalism, not only for the diagnosis of the simillimum, but also for the re-education which is to similimum. This remedial action helps to restore the internal governance and balance of the system and aids it in realising the “higher purpose of existence” (Hahnemann) under the superior guidance of the physician who regards his life as a mission to restore the sick to health(11).
In modern life style, stress plays a major role, for that counselling was needed and it plays important management along with medicine.
As per study, homoeopathic treatment is effective in treating PCOS cases. The totality covering concomitant and constitutional remedy are more effective in treating PCOS. Incidence of PCOS was highly prevalent among the students, working women’s and house wife under the age group 15-25 years. This is the age, were females have more chances for psychosomatisation from their suppressed and repressed emotion due to the value system they hold. From their value system, they have to maintain healthy and balanced environment, when there is any imbalance occurred between intra- and inter-personal relation leads to personality adaptation.
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Dr Fathima Shahunaj MD (Hom)
PG Scholar, Part 2, Department of Homoeopathic Materia Medica,
Sarada Krishna Homoeopathic Medical College, Kulasekharam
Dr Winston Vargheese
Professor Coordinator, Department of Homoeopathic Materia Medica, Sarada Krishna Homoeopathic Medical College, Kulasekharam
Dr Santhi Serene Sylum MD (Hom)
Professor& HOD, Department Of Obstetrics &Gynaecology, Sarada Krishna Homoeopathic Medical College, Kulasekharam