VIPERA AND TRIAD OF ABDO PAIN, FEVER, AND JAUNDICE

Internal Medicine/Knowledge of Disease

Today while studying Vipera I came across this symptom in Boerick Materia Medica.

“Violent pain in enlarged liver, with jaundice and fever; extends to shoulder and hip”

I would like to show here, another way materia can be studied and applied.
Here we are assuming a more pathological approach and would apply knowledge of medicine to study materia medica.

This symptom mentioned above is a triad of pain fever and jaundice. Which is a charcot’ s triad of cholangitis (if the pain is right hypochondrial pain).

Let us now see a differential diagnosis of conditions where this triad of fever, jaundice, and abdomen pain can be present (in all of these conditions vipera can then be thought of based on patient presentation and pathological symptom similarity):

  • Cholangitis- this inflammation of the bile duct causes the classical triad of charcot. It Can be diagnosed on ultrasound and blood picture will generally show neutrophilia. Primary or secondary, it can be associated with ulcerative colitis. The picture is very similar to that present in vipera.
  • viral haemorrhagic fevers- contracted from rodents, bats or insects, these fevers can present with all the features of pain fever, jaundice, coagulopathies, renal involvement etc. Vipera can be a very useful medicine in these fevers.
  • Scrub typhus- caused by bite of an infected mite with eschar formation at bite site, this presents as fever myalgias, enlarged spleen, pain abdomen. Rash, injected eyes and hepatomegaly may or may not be present.
  • Leptospirosis- contracted from infected rats, it presents with fever, pain and jaundice. It also affects kidney function and may cause haematuria.
  • Enteric fevers- caused by salmonella typhi from contaminated water or food, this will present with diarrhoea, constipation, fever with lower pulse rate than expected, low WBC counts. Bilirubin will however may not be raised.
  • Malaria- chills and fevers present in intermittent way depending on type of malarial parasite. There may be enlarged liver and abdomen pain.  The bilirubin doesn’t rise unless haemolysis occurs, causing black water fever.
  • liver abscess- fever, chills and painful hypochondria(rt) are common findings, however jaundice is not a common presentation. It can be easily diagnosed on USG.
  • viral hepatitis- these can present with fever, pain and jaundice. However it is the liver enzymes that are raised markedly in comparison to raised bilirubin.
  • Other acute abdomens such as pancreatitis appendicitis, diverticulitis etc can present with fever and pain abdomen though each will have their own characteristic and jaundice may or may not be present.

(Please note that this similarity is found only while studying the medicine from a pathological point of view. The confirmation can only be done by applying this knowledge in such a clinical condition in a patient.

This kind of approach is especially helpful when:

  • one is not able to find any characteristic symptom or
  • the attendants are not able to give one,
  • there is time constraint or
  • the physician has not seen the patient but has received a diagnosis from attendants.

The results in such prescriptions would nonetheless depend on the accuracy of diagnosis and its pathological similarity to chosen medicine.

References
www.medscape.com
Harrison’s Principles and Practice of Internal Medicine, 12th edition.
Pocket Manual of Homeopathic Materia Medica & Repertory by William Boericke

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com

CONCOMITANTS WITH PAINS

Materia medica/ knowledge of medicinal powers

(compiled from N M CHOIDHRY MATERIA MEDICA and NASH LEADERS)

Pains with desire to take deep breath- xantho

Pains with chilliness- puls

Pains with delirium- veart alb

Pains with fainting- hepar sulph

Pains with irritability- cham, nux v

Pains with numbness- aco, plat, cham

Pains with salivation- plantago

Pains with sleepiness- nux mos

Pains with sweat- cham

Pains with frequent micturition- thuja

Differential diagnosis of NAUSEA remedies

Materia medica/ knowledge of medicinal powers

In an acute case sometimes, it is important to relieve the most troubling symptom. It can however lead us to the right remedy if carefully individualized. These quick tips of differentiating between closely associated remedies aspire to do the same. 

Here you will find how to differentiate nausea of different remedies. The characteristic symptoms which differentiate these remedies are also mentioned for easy understanding.

  • Nux vom- has more of retching than vomiting. Chilliness and irritability.
  • Ant tart- nausea is associated with sleepiness. Rattling in chest.
  • Ipecac- nausea is associated with clean tongue and thirstlessness. Rattling chest.
  • Tobaccum- severe nausea with sweating and sinking in stomach > by uncovering the abdomen.
  • Lobelia- very similar to tobaccum (except the modality), it has however more action on respiratory sphere, rattling chest. Salivation with complaints. Pricking and itching of skin Is a useful concomitant to differentiate it from other drugs. Urine with deep red colour/ sediment with aSbove complaints.

FEVER TREATED WITH BELLADONNA in a k/c/o Gaucher’s disease

Cases

With this case, I want to demonstrate treatment of an acute during treatment for chronic disease. This child around 6 yrs of age was a k/c/o Gaucher’s disease. She frequently suffered from infections for which she had to be admitted and given intravenous antibiotics (she would not respond to oral ones). After each such episode, she took a couple of weeks to recover and regain her strength, only to be battered by the next one. She was under treatment of a senior homeopath who was out of the station and had entrusted me to look after her in his absence. During this period, the child developed an acute episode of severe tonsillitis with high-grade fever. Her parents called late at night (they were not willing to admit her); when I saw her, she had a 103F fever, red lips, thirstless. She was not able to swallow anything on account of the pain. An examination of the throat showed very red tonsils (though no focus of suppuration could be seen).  Belladonna 200 was given and was asked to be repeated hourly with instructions to stop as soon as fever comes down. The parents were advised to admit the child if the fever does not come down or goes further up.

The morning brought good news. The child’s fever came down after just one dose and there was no need for repetition.

Explanation

During the acute episode, consideration was given only to the newly developed symptoms and not to the pre-existing ones. The case became a very straightforward one. Redness (sp. red lips), congestion, thirstlessness, and high fever. These are key indications of bell. The surprise was in the fact that no other dose was needed. This shows that a single dose of similimum can ride the tides (in this case it aborted acute episode). We can either achieve results in a zig-zag way or in the shortest possible way, the latter achieved only by similimum (similar medicine in suitable potency).

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

Download the .pdf version of the case here

FEVER-TREATED-WITH-BELLADONNADownload

DIETARY RECOMMENDATIONS FOR PATIENTS WITH RENAL/ KIDNEY STONES

Patient Management/Removal of maintaining cause

Kidney stones are a very common occurrence among the general population. Low intake of water and a tendency to form stones is one of the commonest causes of their formation.

Depending on the underlying pathology the kidney stones can be of various varieties such as calcium oxalate (most common type), uric acid, struvite, cystine, or fibrin deposit type (the last two are a rarer variety), etc.

They might be either symptomatic or asymptomatic depending on size, speed of formation, location (a smaller stone in the ureter would become symptomatic faster than a bigger one in the pelvis of kidney), or type (c oxalate stones have a tendency to cause haematuria while struvite stones are ass with chronic infection), etc.

Experience has shown that these are most easily amenable to homeopathic treatment. However along with treatment during acute and then constitutional treatment, these cases need to be advised in relation to diet and lifestyle, as the patient’s lifestyle also plays a major role in the formation of these stones.

Following is an easily comprehensible list of advice that patients can follow to walk towards a goal of stone-free life.

Download the pdf now

DIETARY-RECOMMENDATIONS-FOR-PATIENTS-WITH-RENAL-stones-patient-educationDownload

Case of pansinusitis treated with HEPAR SULPH

Cases

A 50 yr old male came with a complaint of chronic pansinusitis. He had been suffering for years with the problem and nothing helped him. He repeatedly took antibiotics to clear up the infection, only to return again. He could not smell anything, could not bear airconditioned environment, and had not slept properly according to his own account for years due to a blocked nose at night. The only time he felt better was when it was warm. He was given a dose of hepar sulph 10m. He returned after 3 months, extremely happy and satisfied, and thanked profusely for the medicine had helped him smell something literally after decades. He slept without any problem and did not need any antibiotics for the past 3 months.

Explanation

An extremely chilly person (he was only ameliorated by warmth) who has pansinusitis (and yellowish discharge) and has taken repeated antibiotics needs nothing but Hepar sulph. I thought that given the chronicity of the trouble he might need some other medicine later on, but it has not been the case till now, even after 4 yrs.

Aude sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

GERD and homoeopathy/ Use of intercurrent/ Removal of Obstacles in treatment – Case of GERD treated with KALI Bi and THYROIDINUM

Cases

A female of 55yrs came with c/o acidity and joint pains. She was not able to sleep at night because of acid reflux. She also complained of joint pains. On detailed inquiry, it was discerned that when she had acidity, she did not have joint pains. They seemed to be alternating with each other. One appeared when the other disappeared. Based on this Kali Bi 200 one dose was given. A follow-up one month later showed no change in her condition. Since I was sure of medicine the potency was increased and Kali Bi 1m.  Even now nothing happened. The case was taken again in detail. I was going to suggest some blood tests but the patient was reluctant to undergo them. It was found that the patient had taken OCPs for a very long time to regulate her periods. On this basis, Thyroidinum 10m was given. This time she responded very well and the follow-up a month later showed marked improvement in her complaints. She was kept on placebo till her last follow-up.

Explanation

I wanted to bring forth a very important point through this case and highlight the need for an intercurrent or another medicine (by whatever name you call it), to remove a block created by prolonged use of OCPs in this case. Kali Bi despite being indicated (acidity alternating with joint pains is PQRS) did not work till the block was removed using Thyroidinum. You will come across many cases like this where a well-indicated medicine will fail to produce results. Look for such blocks/events/accidents/incidences etc, address them with appropriate remedy and you would find them unlocking the case for you or churn the wheels of a machine that refused to budge earlier.

(For those who would like more, I would like to refer to a discussion/case of Dr. S P Dey as mentioned in one of his books “Essays on Homeopathy”. He gives an example of a patient with severe skin manifestations who would be given a dose of Sulph which will apparently cure a patient for time being, only to return 6 months later with a recurrence. He says should Sulph be indicated, as it would be from the symptomatology, it should take care of the case for once and for all, why the recurrence? On delving deeper, it would be found that the mother had skin allergy during pregnancy, in which case Thyroidinum would do the job, or Medo if there’s a family history of sycosis in parents.   These obstacles need to be removed if we are ever expected to travel towards a cure.)

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

Download a copy of the case below.

GERD-and-homoeopathyDownload

Severe acute dysmenorrhoea and homoeopathy – Case of acute dysmenorrhoea treated with NAT CARB

Cases

A 20 yr old girl came with acute severe menstrual pain. She had taken cyclopamine without relief at home. She was given an analgesic and antispasmodic injection (allopathic medication) as well without any relief. As hours passed, her pains increased in severity. It is in this situation that she sought the help of homoeopathy. She was bending double with pain, was crying and trembling as the pain came on. She was given colo 1m, given the severity of her pains without any relief. Bell and mag phos also failed to provide any relief. Almost an hour passed without any change in her condition. I was desperate to provide relief to her but was failing again and again. It was then that I decided to repertorize the case. Fingers crossed, a dose of nat carb 200 was given. She slept in the waiting room after 10 min. Later her scan revealed that she suffered from endometriosis.

Explanation
The rubrics taken for repertorization were:
Pain with trembling
pain with sweating


I used Knerr Repertory (the one I had easy access to at that time).
The only remedy that came in 3+ was nat carb in both rubric. I was skeptical as I had never
used nat carb in acute dysmenorrhoea, but the symptoms chosen were marked and
characteristic, and repertorization result unmistakable. A dose of nat carb 200 showed its
mettle and taught me to think outside therapeutics. (of course, she needed a long-term
treatment of her condition to fully recover).

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com

Download a copy of the case here.

Severe-acute-dysmenorrhoea-and-homoeopathyDownload

Vertical growth/ height and homoeopathy – Case of height increase with TUBERCULINUM

Cases

This is a case of a boy who completed age of 20yrs and wanted to gain some more height. He was 5 feet 4 inches. The boy went to the gym, where his instructor advised him to take homoeopathy. He had an inverted triangular face, long fingers and fine skin (tubercular features). There were no other complaints and he confessed to having stopped growing 2 yrs back.

He was counselled and given a small lesson in growth in males during puberty. He was assured that I would nevertheless give him the medicine, and do what can be done from my side. He was given a dose of tuberculinum 1M and asked to come a month later. Lo and behold, the patient stretched 2cm above Earth. Wait another month and the patient gained another centimetre. In total a gain of 3cm (more than an inch), in 2 months. I had learnt my lesson as well.

Explanation

The growth of males during puberty usually stops around the age of 18 yrs (when the growth plates fuse), it may sometimes be a little later but that is the tail end of the curve. This patient had stopped growing 2 yrs back. The chances were bleak that he would gain any more height. However, my medical wisdom was to be proven wrong. Tuberculinum was chosen based on the physical features of the patient as a guide (as there was no overt disease in the patient, just a latent miasm). It helped the patient gain another inch and a little farther beyond the age one would expect a boy to gain more height. It helped the boy fulfil a part of what his potential was. Maybe if he was to come earlier, he would have benefitted more! But there is no way to know, for there are no parallel universes when it comes to medicine.

Aude Sapere

Dr Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

Download a copy of the case below.

height-and-homoeopathyDownload