Homoeopathy In Haemophilia is a self governing research organization working for the Haemophiliacs through interdisciplinary approach purely on charitable basis.
Project Title:
Homoeopathic Medicines As Supportive Therapy For Managing Severe Haemophilia Patients In A Resource Constrained Set Up Of A Developing Country.
Introduction:
Haemophilia is a genetic bleeding disorder resulting from deficiency of clotting factor VIII (Haemophilia A) or Factor IX (Haemophilia B). The disease affects males where as females are the carrier. A person with Haemophilia (PWH) suffers various bleeding episodes ranging from superficial cuts and bleeds to life threatening intra cranial hemorrhage whereas haemarthrosis remain the common presentation of the disease. Latest Haemophilia census says that there are all together 60-70,000 haemophilia patients are there in the country of which 90% suffers from Haemophilia-A, remaining 10% of Haemophilia B. Only 16,000 are registered in National Haemophilia Register. Remaining patients are undetected due to poor awareness and paucity of latest updated Investigations as available in IHTC only.
Common problems of PWH
Haemarthrosis is the commonest presentation, and can occur 2-3 times/weak. The repeated bleeding in the joints leads to joint deformity thereby increasing the morbidity. Conventional management of the disease includes infusion of deficient factor concentrate/FFP during bleeding phase and physiotherapy is recommended to increase the joint mobility. Repeated infusion with factor concentrate or FFP carry the risk of transmission of transfusion related disorders like Hepatitis C,HIV etc .and may develop Factor inhibitor. A PWH with inhibitor requires to be infused with FEIBA (Factor Eight Inhibitor Bypass Activity). In developing country like India where 80% of population resides in rural areas and more than 80% of PWH belong to lower socio- economic strata having per capita income between 15,000-40,000/year, the exorbitant cost of the standard hemophilia management makes it out of reach of many haemophiliacs. The treatment cost increases in patients with inhibitor positive/ Hepatitis C infection or if there is any associated disease.
Inception of the project:
In view of above a charitable research project has begun in 2007 by Dr. Tapas K Kundu, at Nashik with all necessary Advises, Navigation and Support from Dr. Kanjaksha Ghosh. All Laboratory investigations were carried by in NIIH and IHTC. Hemophilia Federation of India played very important role by providing patients in all centres from the respective chapters and by extending logistic support (in Mumbai and Surat). Homoeopathic medicines are being given as a supportive management during bleeding and non-bleeding phase with the following objectives.
- To minimize the bleeding episodes of PWH without compromising with the quality of life.
- To increase the adaptability of PWH.
- To reduce morbidity.
Treatment plan:
During acute bleeding episodes homoeopathic medicines based on the law of similia (TOS) are prescribed along with the use of Hammamelis Q as a local application (cold fomentation). In case of haematuria, where factor infusions are generally avoided, the same is given orally dissolved in water. Patients are asked to maintain a diary noting the number of bleeds, amount of factor utilized , daily activities , any psychological upsets or altered behavior. A detailed case report format is filled and a constitutional similimum is prescribed based on symptoms pertaining to emotions/psychology in response to the disease(Cognitive symptoms- obtained from interaction with the patients and gist from the diary), behavioral changes adopted to cope with the disease( Conation) along with characteristic physical and particular symptoms. The repetition of the doses is done according to the susceptibility. The disease is managed as per the severity under three levels.
Level I: Advocated For Patients As Self Management
- Soak a gauz piece with hammamelis q 10-15 drops
- Apply over the affected part q +1 cup water for 15-20 min
Level II: frequently used medicines with indication (Acute Prescription)
- Calcarea Carb 1M- Muscle haematoma with ecchymosis.
- Bryonia Alba 30- Painful swelling of the joints ameliorated by rest.
- Apis Mellifica 30/6- Swelling of joints with effusion and redness of overlying skin.
- Ledum Pal 30- Pain/swelling of the joints ameliorated by cold fomentation.
- Arsenic Album 6/30- Restlessness with pains and amelioration by warmth.
- Lachesis 6/30- Increased activity of children inspite of injury or pains. Bleeding dark in color.
- Phosphorus 30-Bright red bleeding with anxiety.
- Rhustox 30-A/f over exertion of the muscles. Amelioration by continuous motion.
- Silicea 30/200/1M-Sense of responsibility despite the sufferings. H/o-repeated factor/cryo ppt/plasma infusion.
- Merc Sol 200/1M- Individuals reacting violently with pains associated with intense thirst and flabby tongue.
Level III: Selection Of Constitutional Similimum Based On
1.Persistant behaviour of the patient obtained from
- The Daily Dairy
- Physician’s Observation
- School teachers’ report or peer report.
- History obtained from the case performa
- Emotional/psychological symptoms
- Physical Generals
- Particulars
3.Physician’s Observation
- Miasmatic Diagnosis
*** In all three levels the medicine is selected as per the law of Similia and also the unified decision of the treating physicians (at least two) and where Fleiss kappa is substantial.
Evaluation of the patients: Besides noting the number of bleeds, patients are evaluated as per the following scales by the physicians.
- Pain Rating Scales: a.Wong Baker Pain rating scale(0-10) for children below 10 years
- Numerical pain rating scale(0-10) for individuals 10 0r above
2.Vineland’s Adaptive Mal adaptive behavioral scale (0-24) (Modified-2007)
- Activity (0-8)
- Co-operation (0-8)
- Communication Skill (0-8)
- SF-32 joint mobility scale.
- Pain Type
- Swelling (Measured In Cm)
- Range Of Motion
- Disability
4.Frequency of bleeds:
- Number of bleed
- Duration of bleed
- Healing time
- Factor required/not/amount of factor required.
Service To PWH:
To start with 14 PWH were enrolled during first camp at Nashik, which slowly went on increasing and till date we have treating total no of 806 patients in our three nodal centres and three sub centres (Table 1). The PWH from various parts of Maharashtra and India are being treated under Nashik Centre. Extending the service to other parts of Maharashtra and Gujrat, haemophilia centres such as Mumbai, Surat , Miraj and Amrawati has started with 313,81,46, 42 patients respectively.
| Updated till 30-04-2015 | Nasik | Mumbai | Surat | Miraj | Amrawati | |
| Parel | Dombivali | |||||
| Total number of Camps Conducted | 89 | 87 | 49 | 30 | 16 | 2 |
| Emergency & telephonic prescribed | 3,047 | 429 | 337 | 255 | 54 | 6 |
| Total number of interactions with patients | 11,141 | 1798 | 486 | 281 | 234 | 73 |
| No. of patients | 324 | 232 | 81 | 81 | 46 | 42 |
| Total Patients | 806 | |||||
During monthly camps along with homoeopathic medicines, physiotherapy and psychological counseling are also provided.
All emergencies are attended by the corresponding centres as they belong to.
The achievements:
- As an outcome of the study the research paper saw the light of publication under the
ELSEVIER-Homoeopathy entitled ,” Homoeopathic medicines substantially reduce the need of clotting factor concentrate in haemophilia patients: results of blinded placebo controlled cross over trial. Homeopathy (2012) 101, 38-43, 2011.
2.The homoeopathic medicines are found to reduce the episodes of bleeding as well as effective in the management of acute bleeding episodes whether concealed ( Haemarthrosis, intra muscular bleeds especially psoas bleed) or open ( epistaxis, bleeding from injury, fall of teeth, conjunctival or haematuria). The analysis of this study is under the process of publication.
Social Impact Of The Project;
- The prevalence of PWH of factor inhibitor ranges from 8.2-13%.This percentage is observed to reduce to a great extent as only 1% of haemophiliacs under homoeopathic treatment were found to be positive for Inhibitor.
- With homoeopathic medicines as a supportive therapy the cost of the disease management greatly reduced. Savings on Individual patient’s average usage at a rate of Rs 10/IU on (12347-864 ) e. 11383 Iu X 10 = Rs. 1,13,830 /patient/ year.
Cost of homeopathic medicine including doctors fee will not be more than Rs. 4000/ year. Hence final overall financial gain with better health status as they bleed less often is Rs 1,09,830/ pt/ year.
OTHER PROJECTS:
- Carrier Mother Project:
Genetic counseling is the main tool for the prevention and control of the disease, targeted at families with affected birth or with a family history of disorder. A project for carrier mother is started with the view to limit the transmission of faulty gene to the offspring. The success of this project might reduce the incidence of haemophilia. The females planning to conceive are given Homoeopathic similimum and is repeated in infrequent interval during pregnancy.
- Patients with Hepatitis C Haemophiliacs developing Hepatitis .C infection as a consequence of repeated factor infusion are also being treated.
- Patients with Inhibitor: Patients diagnosed as FVIII Inhibitor positive are also being managed with homoeopathic medicine.
- Counseling: Most of the females experience marital conflict on account of being carrier of the disease. These conflicts are taken care by psychological counseling with the parents and family members. Carrier young girls prefer to stay unmarried to avoid problems in future. These females are motivated to take up positive decisions in life.
Funding For The Project:
The project is being run for past seven years on charitable basis. The medicine and other logistic support are managed by the project co-coordinator and Investigators.
Pople Behind The Project
Principal Investigator:
Prof (Dr.) Tapas Kumar Kundu
BHMS (Cal), PGDPC, MS(Ibms)
E-mail:- dr_kundu2002@yahoo.co.in
Co-Investigators: Dr. Afroz Farooque Shaikh, Dr. Priyanka D. Singh,Dr. Aafiya Sheikh, Dr. Hiral Shah Bothra, Dr. Omkar R. Kumat
Visit:- www.homoeopathyinhaemophilia.com
Courtesy : The paper orginally presented in world homoeopathy submit at Mumbai by Global Homoeopathy Foundation (GHF)
‘Mind Symptoms’ and ‘uncommon
symptoms’ (for selecting the remedy) are not what you have learnt but they are,
in reality, something different which you ought to know and learn.
–Explanation of Section 213 and 153 of the Organon—
Dr. V. KRISHNAAMURTHY
C-4/4. Silver
Park Apts (Opp. Hindi
Prachar Sabha), T. Nagar, Chennai – 600 017
Phone: 044-24360013, 09884612450.
E-mail: jaykrish1966@gmail.com
Again,
most of the valuable ‘mind’ or ‘uncommon’ symptoms cannot be classified under
any head in the repertories and the conscious homoeopath has to learn them by
rote. (‘rote’ means mechanical or habitual
repetition—Oxford). Therefore, in many cases (if not all cases),
homoeopathic software is of no use, however costly it may be and however
praised by the so-called leading homoeopaths.
The following
actual cases cured by the author would give the reader a clear and accurate
meaning of ‘mind symptoms’ and ‘uncommon symptoms’ in a matter-of-fact way. Dr.
Hahnemann advises that without prescribing on mind symptoms a cure is not
possible (Section 213 of the Organon.) ‘Anger’, ‘restlessness’ etc. are
‘common’ symptoms of mind. ‘When Section
213 is read with Section 153, we infer that we have to prescribe on ‘uncommon
mind symptoms.’
Case 1: A
renal failure patient under dialysis and waiting for kidney transplant, was
under our treatment. We could not find his remedy.
There
is no guarantee for kidney transplant, because after a few years, many patients
die because sooner or later the donor kidney stops functioning. After
transplant he was heard saying, “Now I feel as if I am released from prison . .
. as if I have taken a rebirth.” This he said because he is now freed from
torturing and exhausting bi-weekly dialysis, taking rest, body becoming weak
etc.
This
mental picture of the patient should at once bring to our mind the following
words:
…desire
to be released from what seems to be a perpetual burden of sorrow… (See
p. 111 of the Final Mat. Medica of Mind Symptoms by the author)
We
are going to give Ignatia to him and we are confident that his other
kidney would start functioning and even if the donor kidney fails he would live
long.
CASE
2:
A patient with weeping eczema etc., came to me and said, “Doctor, I am not
taking the treatment to live long. But I have an aged daughter to be married
and a son who is looking out for a job. Who would come forward to marry my
daughter, if I have a weeping eczema? Only because of that, I want to get
cured. Before I die, I want to settle things in my family; my daughter getting
married and son getting a job. Then I can die peacefully.”
Under the remedy
Petroleum (Boericke’s Materia Medica) we find the following:
Feels
that death is near, and must hurry to settle affairs.
Now, this
sentence fits with the remarks made by the above eczema patient. This remedy
was given in single dose and it cured him completely.
CASE 3: A peptic ulcer
patient’s condition worsened day by day and allopathic antacids were giving
only temporary relief. At the height of his suffering (hunger pain with burning
sensation in the food pipe, temporarily relieved by eating) he was heard
saying, “I think that my end is approaching; I must call the lawyer to write
the will; that this hotel of mine should go to my wife; money deposited in the
bank is for my son. My widowed sister who has been living with me for several
years and helping me should take the house which I bought recently.”
This mind
picture agrees with the remarks made by the patient in case No. 2 above. One single dose of the remedy Petroleum-10M
cured this patient as well. We do not
prescribe on names of disease or pathology but on ‘uncommon’ symptoms having no
relevance to pathology. Anger, irritability etc. are not ‘uncommon mind
symptoms’.
CASE 4: A seventy year
old carpenter was under my treatment. During
one of his visits he was accompanied by his 48-year old son. The latter was
coughing with chest congestion etc. The carpenter told his son; “Why don’t you
also take treatment from this doctor. See how much I have improved, whereas the
other seven doctors to whom I consulted earlier could not do anything in my
case.”
To
this, the son said: “The new house where I shifted has no raasi.”
(‘Raasi’ in Tamil means luck). In other words the person feels that everything
was going wrong ever since he started living in a particular house. So, that
house has no raasi. Or, a person feels that ever since he bought and started
using a car, nothing went right. He attributes his sufferings, failures,
difficulties etc. to that vehicle. I hope the reader would understand this. The
son continued, “Even the new work place where I am going daily is not raasi (or
has no good luck.)”
The
other word to describe ‘raasi’ would be ‘sentimental’ ‘luck’. The carpenter’s
son was not ready to take treatment from me only because he felt that the house
and the work place is the cause of his respiratory complaints.
I
gave him one dose of a remedy telling him to take that and he need not pay me
any fees. He took it. (Later I learnt that he was completely cured.).
Can
the reader tell me what remedy I gave the patient?
MIND Symptoms:
Superiority of Lilienthal:
Read
the remedy Staphisagria in the chapter Melancholia in Lilienthal
(p. 701.) There we find the following:
Inwardly gnawing
grief and anger, he looks at everything from the darkest
side . . . disinclination to work and think; dread of the future
and dread of being constantly pursued . . . a sorrowfulness
ending in paralysis of the intellect . . .
Homoeopathy
is an exact and accurate subject. Precision and versatility is its culture. No
one can practise it from imagination.
The
enthusiastic reader would be eager to know how I selected this remedy for the
above case.
(a) Reproaches
others (blaming the house and work place.)
(b) Sentimental.
I write down the remedies common to both
the above rubrics in Kent’s
Repertory (Mind) and read them in the chapter Melancholia in Lilienthal.
Staphisagria suited the symptoms of the case.
Case 5: A
lady of forty-two came with a large calculus in her urinary bladder. She said
that allopathic doctors advised surgery as the only answer but she declined to
undergo it. She continued that she had already undergone two caesarean sections
and one appendicectomy; after each one of these surgeries, her general health
came down. Therefore she cannot afford deterioration of health any further with
another surgery and that she must safeguard her health for the remaining period
of her life. Under the remedy Nux vomica (p. 128 in the Final Mat. Medica of
Mind Symptoms by the author) we find the following:
Afraid she may not have enough to live
on.
Nux-vomica-1M
one single dose was given in the evening. Not only her general health improved,
but also the size of the stone started reducing. (Patient still under
treatment)
CASE 6: A chronic renal
failure patient came to me with a few relatives, all of whom were allopathic
doctors. They showed me a file containing the medical papers of the patient. After this, one by one,
the relatives went out.
The
patient was still sitting. He said, “Doctor, my sons say that I am sick and so
I should not ride bicycle, go out and do our business. They say they will do
everything and ask me to sit at home taking rest. As my children, they should
only tell me that I am all right and I would recover soon. But instead of encouraging me for speedy
recovery they have branded me as a permanent and incurable patient.” [The reader may
note here that in most cases the ‘uncommon’ symptom (on which we can make a
prescription) is told by the patient at the end of the consultation, or, in
some cases, after you have made the prescription! In yet a few cases,
during the second or subsequent consultations!]
This
patient feels that his sons, instead of encouraging, are letting him down. What
one requires from the relatives is not money nor help but moral support. In
this case the patient feels that this is completely missing.
This
symptom we find in two remedies. (See the Final Mat. Medica of Mind
Symptoms by the author. p. 114 and 147) They are
“… a feeling of moral deficiency…” – Kali- brom.
“… despondency, sadness, moral
depression and relaxation…” – Tarentula hisp.
Tarentula hisp.
10M – single dose was given.
Case 7: A
lady of fifty-five, school teacher, was under my treatment for three months for
sinusitis with little relief. She lives thirteen kilometers away from my clinic
and she works in a school which is nearer to my clinic. Before going to the
school she would come to me once a month, take medicine and go to school.
Seeing no relief in spite of three visits, I told her that a certain
acupressure doctor would come and give just 3-minute treatment once only and
for this she need not pay any fees and also I assured total relief. Since the
acupressure doctor comes to my clinic on Sundays only I asked her to come on a
Sunday. To this she replied, “I have to come all the way… from … (her
residence.)”
During
the earlier three visits she would come to me in the morning before going to
her school which is near my clinic. Sunday is holiday for school and she feels
it an ordeal to come for acupressure treatment all… the… way from her residence
thirteen kilometers away.
It
is hesitation. I told her no need to pay any fees for the one-time acupressure treatment
and 100% cure was also assured. Therefore, travelling thirteen kilometres won’t
be a crime. But to do this she has hesitation.
In
the above said case, for merely travelling ten kilometres they have lot of
hesitation as if I am asking them to do some crime or immoral thing. In other
words, they are over conscious of a trivial thing. The apt term would be
“Conscientious scruples.” This symptom is in the remedy Arsenicum album. [See
the Final Mat. Medica of Mind Symptoms by the author. p. 77.]
Let
us repeat, that uncommon mind symptom may be in most cases one only, and the
computer-software or ‘remedy finders’ are of no use. One single dose of
Arsenicum Album-10M completely cured the above sinusitis patient and even
acupressure treatment was not given.
On this symptom,
let us now see two more cases:
Case 8:
This is a cancer patient and after the consultation was over, I asked my fees
of six thousand rupees. To this he replied, “Money… is…” (The sentence was
incomplete and hesitation was as if they are asked to do some immoral act.) He
should say that either he has no money or that he would try to borrow from
relatives. But he does neither. Ars. Alb-10M, one single, dose cured him.
The
above two cases would illustrate the meaning and interpretation of mind
symptoms of a patient. In some cases the repertory or software is not useful
and you have to learn by rote these uncommon mind symptoms.
Let
no one practise homoeopathy without the help of Lilienthal.
Precision
and versatility is required to practise homoeopathy.
The most useful
books for mind symptoms are:
(1) Dr.
Samuel Lilienthal’s Homoeopathic Therapeutics.
(2) Dr.
William Boericke’s Mat. Medica.
(3) Wilkinson’s
Final Materia Medica (Compiled by
Dr. V. Krishnaamurthy).
(4) Final
Repertory of Mind Symptoms.
Lilienthal is
ten times worth its weight in gold.
Case 9: A
patient with chronic headache, after spending much money with various doctors,
specialists and homoeopaths came to me. After finishing the history of his
seven years’ pain in head, he ended up saying: “Doctor, if you or anyone can
cure me of this terrible headache, I won’t mind even giving away half of my
property (worth three millions) to that doctor.” Doctors of all other systems
would simply ignore this statement of the patient.
If
a patient is ready to pay 1.5 million… I thought over this. I took this as a
challenge to homoeopathy. I asked him to first pay me ten thousand rupees and
also give me two weeks’ time with a promise that if I do not cure him in one
single dose (or a few doses) I would pay him double the amount paid by him.
Also, if he is cured he may pay me another ten thousand rupees. He agreed to
this condition and paid ten thousand rupees.
I
took a copy of Boericke’s Materia Medica
and went to a professor of English and requested him to render me a help. I
told him that he has to read the lines given only under the chapter ‘Mind’ in
all the remedies in Boericke’s Mat. Med. and underline if any relevant line is
found equivalent to the statement of a person who says that he would pay half
of his wealth if his headache is cured. I paid him five thousand rupees (which
the professor said is more than sufficient for the work)—It may take a few
days, daily spending two or three hours to go through the lines given under the
chapter ‘Mind’ in Boericke’s 688-page materia medica.
To
another professor of English I gave a copy of Wilkinson’s Mat. Medica and
paying him the remaining five thousand rupees requested him to do the job of
reading the lines given only under the chapter ‘Mind’ in all the remedies (and
this too would take a few days, daily working for three hours) and tell me if
he finds anything equivalent to the above said statement of the headache
patient.
The
first professor (using Boericke’s) could not find anything apt. But the second
professor underlined and pointed out the following lines in the remedy Stillingia
(under ‘Mind’ in Wilkinson’s).
“Deplorably downhearted; suffering
extreme torture from bone pains.”
Stillingia
1000, one single dose cured the patient and he paid me another ten thousand
rupees. After this case I cured two more patients with Stillingia. both
of whom said the above words (ready to give his entire wealth to the doctor who
cures him).
Diligence and knowledge
of English language, both to the core, are required to practise
homoeopathy.
Case 10: Here
is another case of headache. This 55-year old male patient remarked: “Doctor,
all these years I have been having these pains; my sufferings are such that no
amount of compensation would be equal to it. Even if you make me the President
of all the nations in the world that would not be a sufficient compensation.” I
told him the same condition which I put to the patient in the earlier case.
After taking ten thousand rupees I went to the two English professors, one with
Boericke and the other with Wilkinson’s Mat. Medica. In this case the
professor going through Boericke’s Mat. Medica could help me. He pointed to the
following found under the remedy Selenium.
“Extreme
sadness. Abject despair,
uncompromising melancholy.”
Selenium 10M, one dose
cured the patient and he paid me ten thousand rupees.
On
a later occasion the above said professors asked me what I did by their help
and I showed them how I practise homoeopathy. Soon both of them started
learning and practising homoeopathy.
Homoeopathic system of medicine is exact
and accurate. Precision and versatility is its culture.
In some cases
Calvin B. Knerr’s repertory is excellent to work out cases with
mind symptoms.
The other day I
was sitting by the side of a senior homoeopath in his clinic. A patient entered
and asked, “Do you have medicine for diabetes?”
Doctor: Yes,
tell me your symptoms.
Patient:
(Stretching his hand towards the doctor).
“see
my pulse; give medicine.”
[The tone of the
patient was in a commanding note similar to a king, who, when anything is
required would order, “Bring the head of the thief in two hours.”]
The doctor
turned towards me and said, “See doctor, these patients don’t tell symptoms.
How can I prescribe?” That doctor always thinks “Sensation, Locality
Modalities, concomitants. What a wrong teaching?” I took Calvin B. Knerr’s
Repertory and showed him the following:
MIND, Answers,
imperiously: Lycopodium.
Further I showed
him the following from Wilkinson’s Mat. Medica under the remedy Lycopodium:
“Talks
with an air of command . . . manner stiff and pretentious.”
Lycopodium 10M,
one single dose, cured this patient of his diabetes.
—————
Congratulation : let the work be made aware thru our colleges , it would create confidence in our students,
.