Intermittent fever is the most common presentation of infectious diseases, presenting either as a main or an accompanying symptom. There are great possibilities and evidences available for intermittent fever being cured with homoeopathic approach. Since ages, fever has been recognized as one of the hallmarks of a clinical disease. Keeping a track on body temperature with respect to onset, duration and termination, it becomes easier to perceive the nature of intermittent fever.
Even before the discovery of malarial parasite, right from the Hahnemannian era till today, homoeopathic physicians have been treating episodes of intermittent fever. But it is necessary to look into the specific nature of paroxysm along with the strongest and the most peculiar symptoms as observed in each individual case.
FUO – fever of unknown origin.
Presence of intermittent fever during infectious diseases is common and had been variedly taken at the individual level by the practitioners. Frequent infectious causes of intermittent fever include focal bacterial infections, infections localised to canals like urinary or biliary ducts or the colon, and infections due to a foreign material. Other causes includes infective endocarditis, tuberculosis, or malaria, or exceptional like borreliosis, ratbite fever, chronic meningococcemia or chronic Epstein – Barr virus infection.1It requires careful anamnesis and clinical examination as well as a few laboratory investigations, preferably performed during a febrile episode to get sufficient to set the limits of possible further more complex investigations. In homoeopathic system of medicine, the term “intermittent fever” has been used for fever with paroxysm composed of two opposite alternating states (cold, heat – heat, cold) or more frequently three (cold, heat, sweat). Therefore, it is necessary to look into the specific nature of paroxysm along with the strongest and the most peculiar symptoms as observed in each individual case.1
Since ancient times, fever has been recognised as one of the hallmarks of a clinical disease. With the accurate recording of body temperature becoming possible in the eighteenth century when the Dutch inventor Farenheit introduced the thermometer, it was possible to classify it into different types. A German physician, Wunderlich, in 1868, emphasised the clinical usefulness of recording body temperature based on his observations of 25,000 patients. Fever may appear in both infectious as well as non-infectious diseases and holds a central role in the definition and pathogenesis of heat-related illnesses such as heat stroke2.
Most of the fevers are caused by infection but there are many other diseased states wherein fever may occur. Febrile states not after disordered thermoregulation, as in hypothalamic lesions, are due to the release of endogenous pyrogen. Fever may be caused by endogenous pyrogen (EP) which acts on receptors in the thermoregulatory hypothalamus. Fever may be produced by an increase in the production of local prostaglandin (PGE2), monoamines, cations such as sodium and calcium, or cyclic adenosine monophosphate. Exogenous stimuli of endogenous pyrogen (EP) release from its source in monocytes, liver, spleen and lung macrophages, keratinocytes, polymorphonuclear cells, vascular endothelial, and smooth muscle cells, and kidney mesangial cells include: lipopolysaccharide (endotoxin) of gram-negative rods, viruses, other bacterial products, fungi, etiocholanolone, antigen-antibody complexes, polynucleotides, and other antigens. Viruses, tumors, and hypersensitivity reactions to drugs and other substances may stimulate endogenous pyrogen (EP) release from monocytes indirectly via lymphokines secreted after interaction with sensitised lymphocytes.
The cause of fever is often evident from the history, physical examination, and initial laboratory and radiologic studies. Looking into the myriad causes in an organised approach is a formidable task for the clinician, the approach needs to be directed and well thought out.3
Clinical usefulness of fever patterns has been taken in different patterns: intermittent, remittent, continuous or sustained, hectic, and relapsing. In intermittent fever, the temperature gets increased but falls back to normal (37.2°C or below) every day, while in a remittent fever, the temperature falls each day but not to normal. Both patterns have the amplitude of temperature change is more than 0.3°C and less than 1.4°C. When the difference between peak and trough temperature thy can be called as hectic. Continued fever is a pattern in which there is little change (0.3°C or less) in the elevated temperature during a 24-hour period. In relapsing fever, a variant of the intermittent pattern, fever spikes are separated by days or weeks of intervening normal temperature3.
The aetiology depends on age, duration of fever, and immunologic status. In children less than 6 years of age, an infectious aetiology is the most common cause. The prevelance of collagen vascular disease and inflammatory bowel disease has increased in children between the ages of 6 and 16. In the elderly, there is a higher percentage of patients with giant cell arteritis and “cryptic” disseminated tuberculosis. In some cases, it may remain undiagnosed as in diseases such as atrial myxoma, systemic lupus, factitious fever, and adult still’s disease which have not been reported to cause FUO in the elderly3.
As a generalisation, the longer the duration of an FUO, the less likely are infectious and neoplastic aetiologies, whereas factitious disease, granulomatous disease, still’s disease, and obscure diseases become important considerations.
Right from the Hahnemannian era and still today homoeopaths are treating intermittent fever successfully using homoeopathic remedies much before discovery of malarial parasite. Intermittent fever has a wider scope in homoeopathy and includes all types of fever including malaria as defined in § 235. 4
Dr H. C. Allen, in his book, Therapeutics of Intermittent Fever, had put forward some of the prevailing concepts by respective practitioners as follows:
- “Intermittent fever is a neurosis. Its presentation as chill and heat are distinct; their origin are distinct. The heat is due to the action on the sympathetic system; the chill to the spinal system.”1
- Lord, on intermittent fever says, “We believe intermittent fever is a neurosis, whose seat is especially in the ganglionic system, and therefore only nerve remedies, and particularly such as act on the vaso-motor part, can cure.”3
- Wurmband Caspar on intermittent fever writes, “Acute cases must always be treated by cerebro-spinal remedies; chronic cases by organic remedies.”3
- Burt’s Characteristics understandings are. “There may be two gropus of Ague remedies viz.: Quinine, Gelsemium, Eucalyptus, Nux vomica, Arsenic, and Cedron, whichhave the power of destroying protozoa, infusoria, and cryptogamic fungi; and Eupatorium, Cornus, Salicine, Arnica, Natrummur. Hydrastis correspond to the periodicityof the paroxysm.”3
- Hale’s Therapeutics, p. 609. Bartlett, Salisberry, and others has maintained that the cryptogamic theory, have many followers in our school; and here carbolic acid, salicylic acid, sulphite of soda, etc., must be used to destroy the germs.
Malarial theory- marsh miasm3
The prevailing occurrence of epidemics of malaria was earlier supposed to be the result of decaying vegetable and other organic matter, occurring especially along the rivers with stagnant water. In the present context, malaria is considered as an acute febrile illness caused by plasmodium parasites. People gets infection via bite of infected female anopheles mosquitoes, called “malaria vectors.” There are 5 parasite species that cause malaria in humans, and 2 of these species – plasmodium falciparum and plasmodium vivax pose the greatest threat. In a non-immune individual, symptoms may appear in 10–15 days after the infective mosquito bite. Fever, headache, and chills appear as first symptoms. They may be mild and difficult to recognise as malaria. If not treated within 24 hours, plasmodium falciparum malaria can progress to severe illness, often leading to death.1
Therapeutics of intermittent fever3
- Camphor officinalis: Fever comes along with chilliness and the patient suffers from these symptoms in the early stage of fever as sensation of fever or coryza, watery nose and aggravation of the symptoms of fever by doing a little labour.
- Ipecacuanha: Beginning of irregular cases; with nausea, or from gastric disturbance. Accompanied with dyspepsia, every other day at same hour; fever, with persistent nausea. Tongue clean or slightly coated.
- Aconitum napellus: Fever with skin dry and hot; face red, or pale and red alternately; intense nervous restlessness, tossing about in agony; becomes intolerable towards evening and on going to sleep. Complaints caused by exposure to dry cold air, dry north or west winds, or exposure to draughts of cold air while in a perspiration; bad effects of checked perspiration. Restless, anxious, does everything in great haste; must change position often; everything startles him. Tongue coated white. Intense thirst. Thirst for cold water. Bitter taste of everything except water.
- Belladonna: A high feverish state with comparative absence of toxaemia. Burning, pungent, steaming, heat. Feet icy cold. Superficial blood-vessels, distended. Perspiration dry, only on head. No thirst with fever. Belladonna always is associated with hot, red skin, flushed face, glaring eyes, throbbing carotids, excited mental state, hyperaesthesia of all senses, delirium, restless sleep, convulsive movements, dryness of mouth and throat with aversion to water. Worse; touch, jar, noise, draught, after noon, lying down.
- Glonoinum: For fever due to sunstroke, patient suffering from severe pain.
- Ferrum phosphoricum: If the patient has no symptom of fever, this biochemic medicine should be given to the patient at the regular intervals of 2-3 hours. Take this medicine until fever subsides completely.
- Rhus toxicodendron: Adynamic; restless, trembling. Typhoid; tongue dry and brown; sordes; bowels loose; great restlessness. Intermittent; chill, with dry cough and restlessness. Great restlessness, anxiety, apprehension; cannot remain in bed, must change position often to obtain relief from pain. Corners of mouth ulcerated, fever blisters around mouth and on chin. Tongue: dry, sore, red, cracked; triangular red tip; takes imprint of teeth. Great thirst, with dry tongue, mouth and throat. Aggravation; during sleep, cold, wet rainy weather and after rain; at night, during rest, drenching, when lying on back or right side. Amelioration; warm, dry weather, motion; walking, change of position, rubbing, warm applications, from stretching out limbs.
- Nux vomica: This medicine is cold natured but it is used in that condition when the patient feels cold and heat alternately. Fever; Cold stage predominates. Paroxysms anticipate in morning. Excessive rigor, with blueness of finger-nails. Aching in limbs and back, and gastric symptoms. Chilly, must be covered in every stage of fever. Perspiration sour; only one side of body. Chilliness on being uncovered, yet he does not allow being covered. Dry heat of the body. Oversensitive: to external impressions; to noise, doors, light or music; trifling ailments are unbearable; every harmless word offends. Bad effects of coffee, tobacco, alcoholic stimulants; highly spiced or seasoned food; over-eating; long-continued mental over-exertion; sedentary habits; loss of sleep; aromatic or patent medicine; sitting on cold stones, especially in warm weather.
- Lycopodium clavatum: Fever; chill between 3 and 4 p.m., followed by sweat. Icy coldness. Feels as if lying on ice. One chill is followed by another. Neglected pneumonia, with great dyspnoea, flying of alae nasi and presence of mucous rales. For persons intellectually keen, but physically weak; upper part of body emaciated, lower part semi-dropsically; predisposed to lung and hepatic affections. Ailments from fright, anger, mortification, or vexation with reserved displeasure.
- Bryonia alba: This medicine is also useful in typhoid too. Fever; Pulse full, hard, tense, and quick. Chill with external coldness, dry cough, stitches. Internal heat. Sour sweat after slight exertion. Easy, profuse perspiration. Rheumatic and typhoid marked by gastro-hepatic complications. Complaints: when warm weather sets in, after cold days; from cold drinks or ice in hot weather; after taking cold or getting hot in summer; from chilling when overheated; Lips parched, dry, cracked. Dryness of mouth, tongue, and throat, with excessive thirst. Tongue coated yellowish, dark brown; heavily white in gastric derangement. Bitter taste. Aggravation; warmth, any motion, morning, eating, hot weather, exertion, touch.
The aim of homoeopathic medicine for malaria is not only confined to malaria but also addresses its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several medicines are available for management of malaria that can be selected on the basis of cause, sensation, extension and modalities of the complaints.
Conflict of interest: Nil.
- Allen H C, Therapeutic of Intermittent fever. Edition-reprint edition 1990 B. Jain Publishers, New Delhi. 220 pages,
- Lawrence D. and James F. S. Chapter 211, Fever, Chills, and Night Sweats, Clinical Methods: The History, Physical, and Laboratory Examinations.Walker HK, Hall WD, Hurst JW, editors Boston: Butterworths; 1990. 3rd edition. https://www.ncbi.nlm.nih.gov/books/NBK324/Assessed on 8th Nov. 2020
- WHO, Health topics, Fact sheets, details, Malaria, 30th Nov. 2020, https://www.who.int/news-room/fact-sheets/detail/malaria, Assessed on 5th Nov. 2020
- Hahnemann S. Dr. Organon of Medicine 5th Edition published by B. Jain Publisher, New Delhi
Department of Homoeopathic Repertory, G. D. Memorial Homoeopathic Medical College & Hospital, Patna