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Dr Prasad Rasal
Sai-Swami Homoeopathic Hospital, Research Centre & Maternity Home,
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Maharashtra,
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Tuesday, May 26, 2015

Non Surgical Homoeopathic Management of Lumbo - Sacral Disc Prolapse


Homoeopathic management of disorders of Lumbar inter-vertebral discs
NATIONAL JOURNAL OF HOMOEOPATHY 2003 Jul / Aug VOL V NO 4.
Dr Prasad Rasa
l


In aphorism No 3 of 6th edition of organon of medicine, Dr Hahnemann says that: The homoeopathic physician should have following knowledge in order to achieve IDEAL CURE.
(1) Knowledge of disease, indications.
(2) Knowledge of medicinal powers.
(3) Choice of the remedy, the medicine indicated.
(4) Proper dose. and
(5) Obstacles to recovery.
So, here the first point explained is of very much importance while dealing with Lumbar Intervertrebral Disc Disorders i.e."KNOWLEDGE OF DISEASE , INDICATION"
The sentence is divided into two parts:
1) Knowledge of Disease: ie understand the pathogenesis and pathology, so we can handle the patient better.
2) And later on how the same disease expresses in an individual ie (Knowledge of Patient- Individualisation.
So, first let us understand the important disorders of LUMBAR INTERVERTEBRAL DISCS.
Two important disorders of Lumbar inter-vertebral discs are: 1. Lumbar Disc Prolapse
2. Lumbar Spondylosis
HOMOEOPATHIC MANAGEMENT
Generally in homoeopathic practice, clinical examination, clinical diagnosis, laboratory investigations and special investigations are overlooked by a number of homoeopaths. Only symptomatic approach is used by them and that’s why even the best Similimum fails as case is treated without understanding of disease pathogenesis. No proper auxiliary methods are tried. That is why, I always use the word homoeopathic management than Homoeopathic Treatment.
We will discuss the management of above discussed Lumbar Inter-vertebral Disc Disorders.
(A) Acute prolapsed lumbar inter-vertebral disc with lower radiculopathy.
In acute phase:
(1) Immediate Hospitalisation and Continuous Lumbar Traction or Complete bed rest depending upon severity of pains (for 4 days to 10 days )
(2) Acute similimum
(3) When patient comes out of pains, gradual Spinal Extension Exercises to prevent further prolapse of inter-vertebral disc.
(4) Ask the patient not to lift heavy weight by direct forward bending.
(B) Chronic prolapsed lumbar inter-vertebral disc with lower radiculopathy
If disease is chronic with ACUTE exacerbation, same management is needed to take over acute episode followed by (and even in chronic disease itself) finding out :
1. Deep Acting Chronic Constitutional Medicine.
2. If needed, use of deep acting bio-chemic medicine supplementation select on General Biological Action of Medicine,
3. If needed, use of miasmatic NOSODE depending on individualisation.
4. Asking patient to avoid lifting heavy weight with direct forward bending.
5. If patient is of old age use of Lumbo sacral corset or belt during working and travelling.
6. When pains subsides, gradual increase of spinal Extension Exercises.
ILLUSTRATIVE CASE
Mr Y S K 59 yrs/M. Retired primary teacher now a Farmer.
First came on - 18/07/1998
Diagnosed case of Degenerative disc disease with marked narrowing of spinal canal at L 3-4 with disc prolapse at L 4-5 causing severe focal canal stenosis. [Xerox copies of Reports MRI attached]. Patient was posted for Laminectomy and Discoidectomy,.
Chief Compalints and Associated Complaints
Since three months.....
Location Sensation Modalities Conc
Rt lower extremity



Posteriorly
Sciatica
throbing, neuralgic
numbenss
Pains






Claudication in both legs
A/F : lifting weight

(sudden)
< lying on Rt. side
< bending toward
< walking
> pressure
> complete rest
< slightest motion
< Walking very small distance


(RF) LE
Past History: Haemorrhoidectomy 1994
Family History: Father - Koch’s
Personal History: 1. Appetite-normal
2. Thirst-Large quantity of water 3-4 hrly
3. Desires-Sweets ++, Tobacco ++, Salt ++
4. Micturition-Normal
5. Bowels-Normal
6. Perspiration-Neck ++, Offensive ++, Staining yellow ++.
7. Sleep-Disturbs due to pains
8. Dreams-Frightful, farm about
9. Thermals-Ambi-thermal, but always desires fans
Mental State: Disturbed due to disease as he has to lie down all the time and cannot work. He is always thinking about disease with fear of surgery. Anxiety about household problems i.e. marriage of son, building house etc. Quiet, yet dominating in house. But fears quarrels. Religious ++, Emotional ++, Loquacity ++, Expressive ++, Dominating ++, Dictatorial ++, Suspicious ++ and doubtful about recovery. Leadership in service previously, Never likes contradiction, irritable with violent ++ anger. Patient has three sons and a daughter. Only daughter married. Always quarrels with cousins regarding farm. Likes to remain in company and tries to maintain friendship.
Physical General Examination:
  • Male pattern baldness with gray hair
  • Flabby and trembling tongue
  • Tall, slender, emaciated
  • Weight: 58 kg
Systemic Examination:
  • Straight leg raising test (SLR) Right side: +ve
  • Femoral roots stretch test (FRST) Right side: +ve
Investigations done: 07/14/98
Hb:10 Gm % TLC - 7400/mm DC: N: 58, L: 37, E: 3 M: 2, B: 0
Tuberculin Test : -ve
MRI lumbo sacral spine: Wide spread degenerative diseased disc with marked narrowing of L 3-4 disc. Large diffuse disc bulge at L 4-5 causing marked thecal sac compression and severe focal canal stenosis. Milder degree of disc bulge at L 3-4 and L 5-S1. Bilateral root compression of L 3-4.
DIAGNOSIS: Severe lumbar canal stenosis due to degenerative disc disease and PID at L 3-4, L 4-5, L 5-S1 with right lower radiculopathy.
CASE ANALYSIS:
Patient has wide spread degenerative disc disease with acute exacerbation of PID with right lower radiculopathy due to lifting weight. So even though disease is originally a chronic dynamic one, it also has an acute mechanical problem Giving only medicine will cure his prolapsed inter-vertebral disc and the radiculopathy. Whenever an inter-vertebral disc prolapses, nerve root oedema develops immediately. Removing nerve root oedema is of prime importance. Absolute bed rest achieves 60-70% of nerve root oedema reduction. So case should be managed properly to get absolute result.
HOMOEOPATHIC MANAGEMENT:
Our main aim is to relieve patient’s suffering as early as possible. Otherwise patient will go for operation.
Patient was admitted in our Homoeopathic hospital for eight days.
AUXILIARY TREATMENT:
Continuous lumbar traction for eight days which provides absolute bed rest. Regular soft diet was provided. Tobacco was stopped completely.
HOMOEOPATHIC TREATMENT:
As the case is of chronic degenerative disease, our selection of drug should be deep acting medicine to cope up the situation.
MIASMATIC BACKGROUND: Considering family history of Tuberculosis, past history of Haemorrhoidectomy and patient’s present degenerative disorder and mental state of jealous, suspicious, quarrelsome, dominating, violent, leadership
SYCO-TUBERCULAR-SYPHILITIC MIASM
is dominating. So our search should be towards such medicine, as to cover all these aspects.
Anti-miasmatic Nosode: Tuberculinum Deep acting chronic constitutional: Lachesis selected on following rubrics
  1. Dictatorial
  2. Jealousy
  3. Suspicious
  4. Quarrelsome
  5. Violent
  6. Loquacity
  7. Pain, lower limb, sciatica, right
BIO-CHEMIC APPLICATION: To help the homoeopathic medicinal action and to hasten cure, I always uses Biochemic medicines in such chronic degenerative disorders based on its general biochemic action of biochemic medicine.
Chronic degenerative disorders of spine with oesteophyte formation is covered by Calcaria-fluor.
Therefore, Four medicines come out:
  1. Chronic constitutional: Lachesis 200. Potency: 200 potency as chronic pathology with degeneration. Single dose is sufficient to arouse the Vitality.
  2. Acute totality: Bryonia 10M TDS. Potency: 10M potency as an Acute Similimum to relieve the spasm.
  3. Biochemic application: Calcaria-flour. 6X - Biochemic dose in decimal scale.
  4. Nosode: Tuberculinum
FOLLOW-UP Lachesis 200 one dose on 1st day.
Next day Bryonia 10M TDS for 10 days.
Calcaria-fluor 6X TDS for 10 Days (Bio-Chemic Application).
HOSPITALISATION PROGRESS: After applying continuous lumbar traction from 18th July 1998, on 3rd day i.e. on 21st, patient’s pain completely relieved. SLR FRST became negative (-ve). Lumbar traction continued for 3 more days. On 24t h, patient was asked to walk for certain distance on plain surface. No pain after walking. Lumbar traction stopped. Only bed rest continued along with medicines. On 25th, patient walked nearly ½ km without suffering. Continued medicines and bed rest.
On 26th, patient walked 1 km without suffering. Patient discharged and called after 10 days.
TREATMENT ON DISCHARGE: Advised Bed Rest as far as possible.While walking, use lumbo-sacral corset. Placebo TDS for 10days
Calcarea- fluor 6x tds for 10 days
FOLLOW UP
08/07/98: Able to walk 2 km on pain surface. No pains. Occasional Coryza.
Auxiliary Treatment: Gradual spinal extension exercises.
Calcarea- fluor.6x BD for 1 month.
09/11/98 : No complaints. Doing exercises regularly. Walks 3-4 km a day.
Can work in field. Continue Spinal Extension Exercises. Calcarea- fluor 6x OD for 2 months.
11/12/98: No complaints. Use of Lumbo-sacral corset only during travelling.
Continue spinal extension exercises. Tuberculinum 1M 1 dose stat (Anti Miasmatic)
03/01/99 : No complaints. Continue spinal extension exercises. NO MEDICINE.
08/28/99 : No complaints. Ct Spinal Extension Exercises.

Non-Surgical Management of the Pyloric Stenosis with Homoeopathy


Mr. B.H.M., 67 yrs, staying at Sangamner, came on 4th Nov 2006,
a diagnosed case of Pyloric Stenosis with complaining of

C/O: Since 36 yrs, But more aggravated since 1 yrs,
Forced out Vomiting as soon as he takes anything;
<> Empty stomach, Vomiting
Pain in Stomach – Constricting, Oppressed, Spasmodic sensation; as if something coming out of it;
<> Warm Food in minimum quantity.
Associated with severe emaciation, weakness, enervation, nervousness;
So weak that not able to sit for Case Taking;
Came with Support of his Son

Past H/O:
Typhoid in childhood
Operated twice for Peptic Ulcer in 1981 & 1999

Family H/O:
Hemorrhoids – Father & Younger Brother
Ca rectum PGF Died
Ca liver Brother Died
Liver Cirrhosis Brother Died

Personal H/O:
Craving: Tobacco+
Aggravation: Onion+++
Stool: Hard; Once in two days
Sleep: Variable
Thermal: Ambi-thermal


Mental State including Life Space Investigation:
Patient was in a state of Anguish due to Pains in Stomach, looking Sad, depressed;
When asked regarding his disease, he told it’s better to die than remaining alive;
He has to get admitted every week for IV fluids due to weakness; Lot of Economical Stress; Done one attempt to suicide by consuming Sedative Pills;
Sighing intermittently when questioned;
Patient was not in a state to give details regarding Life Space Investigation due to pains;
So history is collected from his son.
Patient from Poor Socio-economic Family;
Childhood Average; Studied up to 7th std. Left school because of poverty; Still feels bad about it; started working since that time; Done over work; 12-16 hrs of sedentary work; Started getting Acid Peptic Trouble; Not taken any treatment for it; Later on diagnosed as a case of Peptic Ulcer; Operated first in 1981 for the same; Again in 1999;
Had 3 brothers; 2 died; 1 – due to Liver Cirrhosis & 1 Ca – Liver; Married in 1967; 1 Elder stays separate, never looks towards his illness; Feels left out from his family; Due to illness could not go in to the society; Feels rejected from the society.

Physical General Examination:
Weak, Emaciated, Sunken Face
Wt: 32kg
P: 100/min
BP: 110/70 mm of Hg
Tongue: Dry, denuded patches
Difficulty in Sitting & even Riding on Examination Table due to weakness
Looks: Anxious, Sadness, Depressed; Sighing off an on;

Clinical Examination:GIT: Sunken Abdomen; Scars of previous Surgeries; Tenderness in epigastrium;

Investigations:
Barium meal study 22/301986
No evidence of hiatus hernia or reflux;
Stomach appears grossly dilated;
Persistence residue is seen in the stomach after 3 hours;
Suggestive of Pyloric Stenosis.

Rubrics:
1. Anguish, Pain in, Stomach
2. Sadness, Suicidal disposition, with
3. Sighing, Grief, with
4. Gen: Emaciation
5. Gen: Weakness, Nervous
6. Gen: Onion, Agg.
7. Stomach: Constriction, Pylorus, of
8. Stomach, Oppression
9. Stomach, Pain, Cold, Drinks, after, Agg.
10. Stomamch, Pain, Warm food, Amel.
11. Stomach, Spasms, Pylorus
Result of Repertorisation:
1. Ornithogalum: 13/11
2. Lycopodium: 10/6
3. Nux vomica: 10/6

Homoeopathic Management:
4 Nov 2006
Avoid Tobacco Give Oral Rehydration Sip by Sip
Ornithogalum 200…1 Dose Placebo… tds 10 days

7 Nov 2006
Felt better immediately
Two days consumed some diet
Looking fresh
But today, has consumed onion in diet & again got
3 forceful vomiting
Wt: 33Kg
P: 90/min

Ornithogalum 200…1 Dose repeated

14 Nov 2006
No vomiting thereafter
Looking much happy & fresh
Taking food 2-3 times a day
Wt: 35Kg
P:86/min

Placebo bid… 15 days

03/29/07
Patient never returned for follow-ups
Till yesterday enjoying food & his work
Since morning again got 3-4 forceful vomiting
Again induced due to onion utappa
Wt: 37Kg
P: 78/min
Comparatively looking much healthy

Ornithogalum 200…1 Dose
Placebo… tds 10 days

06/06/07

Patient never returned for follow-ups
Till yesterday enjoying food & his work
Since morning again got 2-3 forceful vomiting
Yesterday consumed Pav Bhaji
Wt: 39Kg
P: 74/min

Ornithogalum 200… 1 Dose
Placebo… tds 10 days

01/03/08
Patient never returned for follow-ups
His son met me & told that he is not having trouble;
That’s why not coming for the treatment.