HOMOEOPATHIC MANAGEMENT OF PAEDIATRIC NEUROLOGICAL EMERGENCIES[1]
Bipin S. Jain MD (Hom), MBA (Education Management) *,
Nandan B. Daptardar, MD (Hom) **
* Principal, Professor and Head, Department of Materia Medica, Dr. M. L. Dhawale Memorial Homoeopathic Institute (MLDMHI), Palghar; Consultant, Paediatric and Neonatology Dept, Rural Homoeopathic Hospital, Palghar
**Lecturer, Dept of Paediatrics, Dr. M. L. Dhawale Memorial Homoeopathic Institute (MLDMHI), Palghar
*Address of correspondence: Dr. Bipin Jain
Email: drjainbipin@gmail.com
How to cite this article:
Jain BS, Daptardar NB. Homoeopathic management of paediatric neurological emergencies. Journal of Integrated Standardized Homoeopathy (JISH) 2019; 02(01)
Received on: March 05, 2019
Accepted for Publication: March 28, 2019
ABSTRACT:
Paediatric and neonatal emergencies are known to be difficult to manage. The Rural Homoeopathic Hospital, Palghar has made available neonatal intensive care unit facilities, which has enabled the management of these cases in association with the paediatrician. We have presented a selection of 6 cases of varied clinical dimensions with astonishing results. This is only a beginning to explore the further reach of Homoeopathic intervention in conditions, which hitherto have not received our attention. Boger’s approach holds promise. Some of the implications of the experience have been listed.
INTRODUCTION:
Paediatric and neonatal emergencies constitute the most dreadful experiences in paediatric practice. Most of these children present with acute seizures, altered state of consciousness, headaches, hypotonia, cramps, muscle stiffness, hemi-para-quadriplegia, and movement disorders (1). Causation can range from prematurity, acute infection, congenital disorder, and metabolic disorder to birth injuries (1).
Modern medicine has a standard protocol incorporating the line of treatment along with ancillary mode of management. Most of these cases have poor prognosis and pose a huge financial burden on the family. Some of these children recover completely, but unfortunately, most live with neurological or neuropsychiatric disability. Being an emergency, one needs an emergency set-up and good ancillary facilities to assist recovery. Having a paediatric and neonatal intensive care unit is a must.
References to the literature and observations of stalwarts makes it clear that homoeopaths can offer a lot in curing fatal neurological conditions (2, 3). Our experience of working in the neonatal intensive care unit (NICU) with paediatric neurological cases at the Rural Homoeopathic Hospital, Palghar in consultation with a paediatrician has shown quite encouraging results. Cases ranging from seizures, altered state of consciousness including coma due to encephalitis and hypoxic ischemic encephalopathy, hypocalcaemia, meningism, and sclerema neonatorum, have either recovered completely or shown significant improvement with Homoeopathy, when even the paediatrician had given up hope. Some of these experiences were discussed in our ICR day in 2016 (4).
This paper will bring about the following objectives:
- Understanding acute neurological paediatric emergencies from the Homoeopathic perspective to evolve an approach to their management.
- Defining and evolving the scope and limitation of Homoeopathy in these disorders.
- Role of the IPD with a fully equipped intensive care and resources of men and material in their management.
- Role of continuous monitoring and observations in formulating the totality and assessing the remedy response.
CASE 1
Date: 4/1/2016
A 2-day-old male neonate was referred to our centre in a comatose condition with an episode of convulsion at 6.30 pm with twitching of eyes and forehead. The mother underwent lower segment caesarean section (LSCS) due to non-progress of labour, transverse lie, and thick meconium-stained liquor. The infant did not cry for 20 minutes after birth and had thus gone through a period of birth asphyxia.
Observations: The baby was sleepless, slow movements of extremities, profuse perspiration all over body, increased respiration, and poor cry.
Examination: Oxygen saturation had dropped to 92%, weight: 2.780 kg
CNS– NO CRY/TONE/ACTIVITY, no suck, grasp, glabellar tap absent, and pupils were dilated
CT SCAN: Showed changes of severe hypoxic ischemic injury to the supra-tentorial brain parenchyma.
Diagnosis: Hypoxic Ischaemic Encephalopathy Grade III (4).
Totality:
| Symptoms | Rubrics with | Remedies |
| A/F- Birth asphyxia | Children – ASPHYXIA, infants | Opium 6/14
Belladonna 6/13 Antim Tart 5/11 Camphora 5/11 China 5/9 |
| Lack of reaction | General- reaction- lack of | |
| Sleeplessness in new-born children | Sleep- INSOMNIA, sleeplessness- children, in | |
| Perspiration profuse | Perspiration- PROFUSE | |
| Twitching in general | GENERAL- TWITCHING | |
| Respiration irregular | Breathing- IRREGULAR, breathing |
(Repertorization done using Radar Opus software)
Based on the state of patient and state of the disease, Opium was selected. Poor reaction indicated poor susceptibility, leading to choose 50 millesimal scale with frequent repetition (6).
Follow-up:
| Symptom
Time |
Sleep | Twitching- eyes | Twitching of forehead | Respiration/O2 SUPPLY | Cry/ tone/ activity/suck | Action |
| 24 H | >+2 | >+ | >+2 | SQ / + | +/-/+/- | Opium 0/1 X 2 HR |
| 48 H | >+2 | >+ 2 | >+2 | > +2 / + | +/-/reduced/- | Opium 0/2 X 2 HR |
| 72 H | N | 0 | 0 | N / 0 | +/-/reduced/- | Tuberculinum O/1 + Opium 0/2 X 2 HR |
| 120 H | N | 0 | 0 | N /0 | Hunger cry/+/+/ + | Opium 0/2 X 4 HOUR |
| 240 H | N | 0 | 0 | N/0 | +/+/+/+ | Continue the same for 4 days |
On 15/1/16, patient was discharged with all reflexes normal, tolerating feeds with normal cry, tone, and activity.
CASE 2
A 3-day-old male infant delivered through an emergency LSCS due to foetal drop on 31/10/15 at 2:49 pm did not cry for 6 minutes, passed urine, did not pass stool, and developed excessive crying, starting at 2 am.
Observation: Comatose, no response to painful stimuli, dilated pupils, no cry, absent tone, activity absent. Stiffness of the lower limb muscles with hypothermia. Oxygen saturation was 95%.
On Examination: Weight 2.2 kg. Temp 96.2℉, RR 34/min, HR- N. Air entry was decreased
There was a pan-systolic murmur.
Cry/tone/activity was absent, primitive reflexes, glabellar tap and grasp was absent. Sucking was poor, Brudzinski and Kernig signs were positive, neck turn reflex was negative
Investigations:
Hb-10.6 mg/dl, W.B.C- 16800, N- 60, L- 34, E- 2, M- 4, platelets 89000, S. creat- 1.1, Na- 135 mEq/lit, K- 6.00 mEq/lit, Cl- 105.5, CRP- positive
Diagnosis: Hypoxic Ischemic Encephalopathy in Grade III (4)
Totality
| Symptoms | Rubrics | Remedies |
| Causation – Birth Asphyxia | RESPIRATION-ASPHYXIA-Children, new-borns | Opium
4/10 Belladonna 4/9 Camphora 4/9 China 4/7 Hyoscyamus 4/7 |
| Tissue Affinity – CNS: Hypoxia and Ischemia in cerebrum, pons and medulla. | HEAD- INFLAMMATION -Brain | |
| Generalities – Lack of reaction coma, Comatose, Painless to deep stimuli, Altered state. | GENERALS- REACTION- lack of | |
| Particulars – Dilated pupils, cold extremities | EYES- PUPILS-dilated |
(Repertorization done using Radar Opus software)
The remedy was selected based on the available pathology and symptoms along with the stage of disease. High potency was decided on, since the reaction was poor.
On this basis, Opium 50 M was selected; it was rubbed externally. When the susceptibility & reactivity is poor, one can give the remedy in high potency with repeated doses (5).
Follow-up:
After 2-3 hours, the neonate started showing pupillary reaction to light.
- By 24 hours, he started sucking and grasping.
- Within 48 hours, the cry tone and activity started. Hunger cry started
- By 72 hours, he was responding to all sensory stimuli.
- On the 5th day, the neonate’s activity reduced and he became lethargic. Therefore, to enhance his state and recovery, one dose of Tuberculinum Bov 1 M was given.
- Opium was continued till he was discharged on the 9th day, but its repetition was reduced gradually.
Learning
- Understanding the clinicopathological state helps in defining the state and stage of disease and hence the state of susceptibility.
- Skill of observation in the paediatric age group helps to define the symptomatology and its significance in the totality and remedy selection.
- Intensive neonatal care is needed for managing these cases along with skilled medical and nursing team
- In-depth knowledge of neonatology allows us to understand the progress of the case and remedy response
- Cases with poor susceptibility with poor reaction respond to high potencies like 10 M, 50 M, LM etc. with frequent repetition. In our clinical experiences at RHH, Palghar both high potency and 50 millesimal potency have been used and have shown encouraging results. More cases would be needed to establish further therapeutic guidelines.
- Intercurrent remedy, whenever indicated, helps in enhancing the recovery.
- Enhancement of scope and limitations in neonatology can occur when we engage with emergencies and explore the effects of Homoeopathic therapy along with intensive care and ancillary measures.
CASE 3
A 5 ½-year-old boy was brought on 14/9/13 to the hospital casualty. The chief complaints had started in the last 8-10 days, but there was history of skin eruptions for 2-3 days 15 days prior. Complaints of fever with chills subsided after a dose of paracetamol. A moderate grade fever was followed by profuse sweating all over. Appetite and thirst decreased during the fever. No time modality was available.
The child came with fever with chills+, moderate grade fever, sweat – profuse, fever with chills -high grade continuous, convulsions- up rolling of eyeballs, clenching of teeth, stiffness, jerky movement alternating with stiffness, involuntary urination during convulsion, unconscious during and since convulsions, frothing +, unconscious since convulsions, appetite+- decreased, thirst+ decreased
An episode of convulsion started in the casualty itself, which was immediately reported to the paediatrician on phone. Paediatrician was not willing to manage this case because of the high risk and non-availability of investigative procedures and paediatric intensive care unit (PICU). The high risk was explained to relatives and they were advised for transfer to higher centre. However, the relatives were not willing. Hence, a decision was taken to continue with the treatment and the following observations were recorded.
He was normal in the febrile state and dull during fever prior to convulsions.
On Examination: Temp- 101℉ (axillary), Pulse- 180/ min, BP- 140/60 mmHg, RR-18/min (irregular shallow), SPO2 without O2- 90%,
Glasgow Coma Scale score (4): E+M+V= 3
Patients scoring 3 or 4 have 85% chance of dying or remaining vegetative (5).
CNS-level of consciousness: Coma. Involuntary movements: Present, no reaction to pain/touch/pressure, Pupils: semi dilated sluggishly reacting to light, Reflexes: poorly elicited, neck rigidity ++
Investigations:
WBC: 15,400; Differential count: N 69 L29 E1 M1, CRP: – positive
Diagnosis: Viral encephalitis with status epilepticus in coma grade III (4)
The patient was deteriorating further, so we decided to start with Homoeopathic medicines and the acute history was taken.
Totality:
| Symptom | Rubrics | Remedy |
| Brain- Affection | [HEAD] Brain, complaints of | Belladonna 6/14
Sulphur 6/8 Pulsatilla 5/11 Phosphorus 5/10 Hyoscyamus 5/9 |
| Blood Vessels | [Heart, Circulation and pulse] Blood vessels | |
| Inflammation | [Generalities]Inflammation | |
| Convulsion | [Generalities] spasmodic or convulsive effects, twitching jerks, etc. | |
| Throbbing, Pulsating | [Generalities] Throbbing, pulsating | |
| Tachycardia
|
[Generalities]Pulse frequent, accelerated, elevated, exalted, fast, innumerable |
(Repertorization done using Hompath software, Repertory – complete repertory 2005)
Looking at the state and stage of disease following viral infection with throbbing, pulsating frequent pulse, Belladonna was selected. Poor susceptibility along with poor reaction dictated choice of higher potency and frequent repetition.
Remedy: Belladonna 10M every 10 min
Follow-up:
| Date and Time | General
condition |
Unconsciousness | Reaction to
Painful/Verbal stimuli |
Convulsion | Neck stiff | HR range | Temp range | Action |
| 15/9/13
8.00 pm |
>+ | sq | Responded to stimuli | — | ++ | 120 | 97.8 F (A) | Belladonna 10M 4 pills diluted in 5 ml distilled water – 1 drop after every 10 mins |
| 16/9/13
(8am) |
>++ | Conscious, oriented to person | Verbal command | — | + | 108-136 | 97.8- 100.6 | Belladonna 10M
2-hourly |
| 18/9/2013 | Improved | –”– | Verbal command | — | + | 110-128 | 96.2-99f | Belladonna 10M 4 hourly |
| 20/9/2013
(8am) |
Good | Conscious and oriented to person and place | Verbal command started walking and talking | — | >++ | 96.6- 97.8 | 96-110/min | Belladonna 10M 4 hourly |
| 22/9/2013
(8am) |
good | –”– | —”—- | — | –0— | Belladonna 10M 4 hourly | ||
| 25/9/2013 | Good | Conscious and oriented | Responding to verbal command | — | –0- | 84-98 | 97-98.2 | Patient discharged |
DISCUSSION:
This was a difficult case in which all had lost hope. After taking a detailed history, it was difficult to find the characteristics in the case. Moreover, the patient was deteriorating rapidly so we had to rely on pathology, tissue affinity, and signs and symptoms. Boger’s approach was used. With the low susceptibility and poor, sinking vitality, higher potency along with frequent repetition was used to arouse vitality. Understanding of the clinicopathological understanding helps in defining the state and stage of disease hence the state of susceptibility. We also learnt that a careful clinical examination can throw some light on remedy selection.
CASE 4
A 6-year-old male infant reported on 5/5/16 in the casualty for frequent convulsions with opisthotonos posture for 10 days, which had increased since 3 days.
HISTORY
A month prior, the patient was playing; suddenly, a dog pounced on him. He returned home crying in a panic state. The same evening, one of his friends frightened him by barking in his ear. He suddenly started with fever for a day. The next day, he developed altered sensorium+2. He was given medicine from the primary health centre (PHC), but convulsions started. He developed frequent episodes with unconsciousness and was referred to KEM Hospital, Mumbai. He was admitted in the PICU for 14 days and was intubated for 12-13 days. He was investigated and diagnosed with meningoencephalitis.
The patient’s family had taken discharge against medical advice (DAMA) from the PICU on 26/4/16. He was taken home, but the convulsions did not stop till he was brought to our hospital.
The patient had increased stiffness of extremities++ with frequent convulsion and intermittent fever. He had sleeplessness+3 since 10 days, could sleep only for 1 hour at the most. The patient had not slept since last 2-3 days and had become physically restless+2.
He had also been diagnosed with chronic suppurative otitis media since 3 months. He had been examined by an ENT surgeon; no perforation of the tympanum was seen.
Treatment given on discharge:
Inj Mikacin as empirical for TB meningitis; Inj Monocef for 21 days; anticonvulsants such as
Syr. Valparin, Syr. Eptoin, Syr. Gardenal T. Diazepam, T. Solonex., T. Levoflox, and T Combutol
On Examination: Rolling up of eyeballs, clenching of teeth with frothing from mouth and jerking movement, Stiffness +3. Tonic clonic convulsion with intermittent opisthotonos posture.
Intermittent Fever on and off
Pupils sluggishly reacting to light+ dilated
Status epilepticus+3, since today morning with opisthotonos posture.
Increased respiratory rate+2 with stridor+2.
Temp- 101.2℉ Ear discharge – yellow sticky pustular +2 Heart rate-130/min RR- 64/min. The patient had stridor.
CNS: Not responding to painful stimuli; Glabellar tap – Absent+
B/L – deviation of eyes+2 Position – opisthotonos+3 Decorticate sign+3
We then did clinical staging of encephalopathy
Final diagnosis: Meningoencephalitis with grade 3-4 encephalopathy (4).
With his ongoing medicines, there was not much effect in his state, so we oriented the parents about Homoeopathic treatment and they agreed. The paediatrician’s opinion was taken and they advised to continue the same medications.
TOTALITY:
| Symptoms
|
Rubrics | Remedies |
| LOCATION: Brain: Meninges
|
HEAD- BRAIN, complaints of, meninges. | Belladonna 9/22
Hyoscyamus 8/17 Calcarea 8/12 Stramonium 7/14 Pulsatilla 7/16 Apis 7/ 11 |
| PATHOLOGY: Inflammation | GENERAL- INFLAMMATION | |
| PHYSICAL GENERAL S/S: Posture: Opisthotonos | GENERAL- CONVULSION- Opisthotonos with | |
| Pupils dilated | EYE- PUPILS- dilated | |
| Physical restless 2 | GENERAL- Restlessness | |
| Sleeplessness 2 | SLEEP- Sleeplessness | |
| CONVULSION- | GENERAL- CONVULSION | |
| MENTAL: Ailments from fright3 | MIND- AILMENTS FROM- fright | |
| Fear of dogs 3 | FEAR- dogs, of |
(Repertorization done using Radar Opus)
Stramonium was selected based on the fear and its effect on the brain and current state of pathology.
Follow-up
| Time | Observations | Thought and action |
| 5th May | Stramonium 0/1 every 2 hourly diluted from 11AM | |
| 24 hours later | Episode of convulsions reduced and there was a single episode. The stiffness started reducing, Decorticate sign was reduced | Stramonium 0/1 every 2 hours |
| On 5th day | Responded to glabellar tap
Pupils intermittently BERL Stiffness was gradually reducing and the pupils were not normally reacting all the time |
Stramonium 0/2 was started every 4 hours |
| On 13th day | He again had opisthotonos and decorticate posture appeared, limbs become stiffer and movements were painful | Increased potency to 0/3 |
| On 16th day | No desired improvement | |
| On 18th day | Patient started with loose stools, he developed hypersensitivity of lower limbs on touch with pointed objects which was causing flexion of hip and painful expression on face | A different picture was emerging. Therefore, we revised the totality according to the emerging form |
.
| Symptoms | Rubrics | Remedies |
| Convulsions- children in | GENERAL- CONVULSION- children in | Veratrum 5/8
Zincum 5/7 Pulsatilla 4/11 Lycopodium 4/10 Nux Vomica 4/9 |
| LOCATION: Brain: Meninges
PATHOLOGY: Inflammation |
GENERAL- CONVULSION- Meningitis, during cerebrospinal | |
| PHYSICAL GENERAL S/S: Rigidity3 | GENERAL- CONVULSION- tetanic rigidity | |
| MENTAL: Ailments from fright 3 | MIND- AILMENTS FROM- fright | |
| PARTICULAR: loose stools <eating after 2 | RECTUM – DIARRHOEA- eating- after – agg. |
(Repertorization done using Radar Opus)
Zincum Met 30 was given stat. His exaggerated reflexes stopped with improvement in frequency and character of loose stools, followed by pupillary reflexes and supine posture. His fever stopped after Zincum. The overall stiffness reduced by 50%. He was looking in the direction of the sound. Zincum was given TDS till his discharge on the 23rd day and was asked to continue for a week. We could reduce the dose of anticonvulsants and frequency of convulsion. The stiffness also reduced to 50%, which shows we have a role in the recovery of these type of cases.
CASE 5
A 5-year-old girl was brought on 3/6/2016 in a disoriented, irritable, restless state with spitting on approach. Convulsions, sudden 5-6 episodes/day lasting for 4-5 min, rolling up of eyeballs+2 with fists tightly closed+2, Tonic clonic movement of extremities, loud shout before convulsion+2. No loss of consciousness. No involuntary passage of urine and stool.
Sleepiness, Conscious +
Fever since 5 days. High grade continuous, with perspiration, no chills
Vomiting+ containing of ingesta
Cough in short bouts+, Rattling cough+2, cough with expectoration watery+.
No breathlessness.
Thirst increased for small quantity after small intervals +2, weakness with decreased activity+2, dullness+, always sleeping since complaint started, irritable +2 (spitting when touched or approached)
Observation in ward: Irritable when touched. Would spit or turn her face to the opposite side.
On examination: Temp- 98.2℉, Heart rate- 94/min, RR- 32/min, Weight – 17 kg, SpO2- 95% without O2
Respiratory examination: Crepitus left lower lobe
CNS: Dullness, reflexes- N, pupils- reactive to light, responds to painful stimuli, no neck rigidity/ no Kernig sign/ no Brudzinski’s sign.
Chest X-ray: Left lower lobe haziness
Investigation:
WBC: 15,400, Na: 126.9, K: 3.8, Cl: 94.3, Calcium: 8.1, CRP: Positive.
Final Diagnosis: Left lower lobe pneumonia with complex febrile convulsion, hyponatremia, and hypocalcaemia.
Totality:
| SYMPTOMS | RUBRICS | REMEDIES |
| Touch aversion+3 | MIND- TOUCHED- aversion to be | Belladonna 7/15
Lycopodium 7/14 Antim tart 7/12 Veratrum 7/12 Cuprum met 7/10 Nat mur 6/13 Arsenic 6/12 |
| Dullness +3 | MIND- DULLNESS | |
| Spitting+ | MIND- SPITTING | |
| Weakness fever | GENERALITIES- WEAKNESS- fever, during, agg. | |
| Increased thirst during fever SQSI+2 | THIRST- small quantities for- fever, during | |
| Cough < night+2 | COUGH- NIGHT | |
| Cough rattling+2
|
COUGH- RATTLING |
(Repertorization done using Radar Opus)
Final remedy: Antimonium Ars 1M 2 hourly
Auxiliary Line of treatment: IV Fluids with glucose and sodium.
Follow-up
In the first 24 hours, the frequency of convulsions was the same, although the last one lasted for 30 seconds. The irritability was reduced considerably, intensity of cough was reduced, weakness was reduced, was able to sit. On the 2nd day, she had a generalized tonic clonic convulsion with rolling up of eyeballs and involuntary urination. There was a loud cry before convulsion and she was in stupor and not responding to verbal stimuli.
| Symptoms | Rubrics | Remedies |
| Brain+ | HEAD- BRAIN; complaints of | Belladonna 7/14
Nux V 7/13 Zincum 7/11 Calcarea 7/9 Stramonium 6/11 |
| Convulsion children in+2 | GENERALS- CONVULSIONS- children, in | |
| Nerve+2 | GENERALS- NEUROLOGICAL complaints | |
| Stupor condition+3 | MIND- STUPOR | |
| Touch aversion+2 | MIND- TOUCHED- aversion to be | |
| Shouting before convulsion+2 | GENERALS- CONVULSIONS- shrieking; with | |
| Neck stiffness+3 | NECK- STIFFNESS |
She was responding to pinches and had developed neck stiffness. The patient was deteriorating, so the totality was revised.
We started with Zincum Met 0/1 every 2 hours. In 12 hours, the patient was awake, not only responding to verbal commands but also talking with parents. No neck stiffness and she was asking for food and water. She had 1 episode of convulsion that lasted for 30 sec. Calcium and sodium levels were still low though we managed to reduce the convulsions. Dullness and sleepiness was there after every episode of convulsion.
On 8/6/16 i.e. on the 5th day, her convulsions stopped. She became active and started roaming around in the ward. She was discharged the next day when she was observed to be completely normal for 24 hours.
The above cases, Four and Five demonstrate:
- Skill of case definition and observation in the paediatric age group is needed to define causation, symptomatology, characteristics, and their significance in totality and remedy selection.
- Careful follow-up and changing forms need to be observed in furthering improvement
- Alertness is needed to understand the changing susceptibility, changing phase, and changing totality to be ahead of the pace of the disease.
In addition, case five also demonstrates:
- Co-morbidity with neurological disorder needing integration of totality and susceptibility to produce a long-lasting effect.
- Alertness to the deterioration of susceptibility to halt the progress of the disease.
Case 6
A 8-year-old girl was brought to the casualty on 29/7/15 in a drowsy state, responding irritably to loud command – just opening the eyes and cranky. She had 8-9 episodes of vomiting after eating spicy food, vomitus: yellowish watery, scanty, non-offensive, A/F: spicy food
Fever with chills with ?convulsions: chattering of teeth, clenching of fists, passing urine involuntarily, dullness++
Irritability on approach++, dullness++, unresponsive to verbal command. responding to painful stimulus, cranky on approach
On Examination:
T: 99 F HR: 100/m RR: 24/m
CNS: Dull++, drowsy. Unresponsive to verbal stimulus. Responding to painful stimulus. Irritable ++ on approach, cranky. No neck stiffness/ photophobia. Reflexes normal
Investigations: on 29/7/15 WBC 12,400, serum electrolyte- Na 128.2, K 4.2, Cal 98.1, C reactive protein – positive. Urine ketone +.
On 30/7/15, MP smear-absent, MP antigen- negative, Na 135.5, K 3.9, Cl: 103.3
Diagnosis: Acute gastritis with meningism
Acute Totality:
| Symptoms | Rubrics | Remedies |
| Ailments – spicy food+++ | GENERALS- FOOD and DRINKS- pungent things- agg | Silicea 5/11
Sulphur 5/10 Phosphorus 4/9 Antim C 4/8 Arsenic 4/8 Veratrum 4/8 Nux V 4/7 |
| Irritability++ | MIND- IRRITABILITY- children, in | |
| Dullness.++ | MIND- DULLNESS- children, in | |
| Vomiting < after eating++ | STOMACH- VOMITING- eating – after-agg | |
| Vomiting < after drinking++ | STOMACH- VOMITING- drinking – after-agg |
(Repertorization done using Radar Opus)
Remedy: Nux Vomica
Remedy Understanding from Boger’s Synoptic Key:
Location: Cerebro-Spinal Axis, Nerves, Digestive Organs, Stomach, Liver, Bowels
Worse: SLIGHT CAUSES; Anger, Noise, Odours, Light, Touch, PRESSURE
Description: VIOLENT ACTION; often irregularly fitful or inefficient. Irritable and hypersensitive, mentally and physically. Active, ANGRY AND IMPATIENT; cannot stand pain; so mad, he cries. VIOLENT VOMITING; bilious-sour. Indigestion.
We also had a strong concomitant of the GIT and CNS. Therefore, we wanted a remedy that has affinity for both systems. Hence, Nux Vom was selected as the final remedy.
Follow-up:
On the 2nd day, the child was conscious, oriented but was cranky on approach. The vomiting persisted. On the 3rd day, vomiting completely stopped. She was active and playful. She started asking for food and water. Nux Vomica was stopped and she was discharged on the 4th day.
Case six demonstrates:
- Sometimes the remedy is not obtained through repertorisation, it can selected after careful clinical evaluation, examination, and understanding the clinicopathological state.
- Understanding the susceptibility where the chief complaint expresses the impact of acute pathology on the nervous system should alert the physician to spot the totality.
- Alertness to spot the deterioration of susceptibility will lead to effective action to halt the progress of the disease
Learning from all the six cases:
- Need to define and evolve scope and limitation of Homoeopathy in neurological disorders
- Need of inpatient department with fully equipped intensive care unit and resources of man and material in management of these disorders
- Need of continuous monitoring and observation in formulating the totality and remedy response.
- Homoeopathy has a definite role in not only arresting the progress but also in reversing the acute neurological processes, including coma.
- Homoeopathy plays an important role in acute neurological emergencies where other systems give up.
- Understanding of clinicopathological evolution plays an important role in managing these conditions.
- One needs to be alert to define susceptibility and its changes time to time in order to form totality and planning and programming.
Boger’s approach is the key to formulating totality
- Ancillary and supportive management is important in improving the pace of recovery.
CONCLUSION:
The clinicopathological approach along with observations of the child helped in formulating totality in the IPD set-up. Constant observations of children in the IPD helped in closely monitoring the follow-up and helped in regulating the remedy response. The ancillary mode plays an important role along with a supportive set-up and round-the-clock availability of PG students helped in entering in a zone that is rarely frequented entered by a Homoeopath. Homoeopathic Post Graduate Institutes having these facilities can go a long way in evaluating the role of Homoeopathy in these emergencies.
References:
| 1. | Kliegman Robert M. Nelson Textbook of Paediatrics. 20th ed. Canada: Elsevier; 2016. |
| 2. | Kent JT. Lectures on Homoeopathic Materia Medica Delhi: B. Jain Publishers; Reprint edition 2005. |
| 3. | Herring C. Herring’s Guiding symptoms of our Materia Medica. First updated edition ed. New Delhi: B. Jain Publisher (P) LTD.; 2003.
4. Jain Bipin, et al: Exploring the utility of Homoeopathy in the Intensive Care of Children and Neonates: A Pointer to the Era of Integrated Medicine? Presented at the ICR Day Celebrations, MLD Trust, 31st July 2016 |
| 5. | Mathers LRF. Pediatric Emergencies, Chapter 66, in Nelson Textbook of Paediatrics. 20th ed.: Elsevier; 2016. |
| 6. | Dhawale M. L. Principles & Practice of Homoeopathy. 5th reprint ed. MUMBAI: DR. M.L. DHAWALE MEMORIAL TRUST; 2008. |
[1] Based on a paper presented at the HOMAI National Conference , November 2018, Patna
