Gout-homoeopathic remedy urtica urens to eliminate uric acid

March 31, 2020 admin Case Presentations 2

Dr Midhun Jose

Gout is an inflammatory joint disease, with increased uric acid level in blood. The deposition of monosodium Urate crystals in the joints leads to inflammation. Important risk factors for gout includes obesity, chronic kidney diseases, intake of high Purine foods such as animal liver, shellfish, alcoholic beverages, etc. The prevalence of gout is mostly seen in men than women. In Recent years the prevalence of gout is increased among people because of the shift in diet and the change in lifestyle. Hyperuricemia is the major feature of gout. i.e., the serum uric acid level rises above 6.8 mg/dl(1). All the hyperuricemic patients do not suffer from gout. Gout mostly develops when there is an increase in production of uric acid with improper elimination. Gout usually affects the joints, periarticular tissues and kidneys. In current scenario, gout affects not only the elderly but also the younger generation. Previouslygout was common in between 40-60 years. Now the peak incidence is between 30-50 years.(2)

EPIDEMIOLOGY:
In normal men taking purine free diet, the daily urinary excretion of uric acid is 350 to 500 mg. In males at puberty the uric acid level is around 5.2mg/dl. In females it is up to 4.7mg/dl, but rises after menopause(3). The incidence and prevalence of gout has increased in the recent years. It is common in urban than rural community. In India the prevalence of gout is 0.12% as per International League of Nations against rheumatism and its prevalence is more in men above the age of 50 years.(4)

RISK FACTORS AND ETIOLOGY:
The gout in ancient times was known as “The King of diseases” since it was present only in high class people(5). But now the incidence is increased because of the change in diet and lifestyle. The risk factors for the gout include alcohol, dietary excesses (meat, sea foods and liver), surgery, trauma, sepsis, stress, starvation, dehydration, drugs like diuretics, aspirin, etc.(6)(2)

Ninety percentages of patients have primary gout in which there is impairment in the uric acid excretion. Secondary gout results from Hyperuricemia due to renal imbalance or from chronic use of diuretics.(7)

CLINICAL FEATURES:
Acute gout- It usually presents with affection of first metatarsal phalangeal joint ( Podagra). Other common sites include ankle, mid foot, knee, fingers, etc. The pain is of rapid onset and is usually seen in morning. The clinical features include pain, tenderness, swelling and shiny skin.

Recurrent gout- In some people recurrence of attack is seen within one year and is usually present with theinvolvement of more joints.

Chronic gout- It is usually present with tophi(deposition of large MSU( Mono sodium urate) crystals around fingers, hands, forearm, toes, and sometimes in helix of ear).(7)

 Renal and urinary tract manifestation- increased uric acid level can lead to renal stone formation. Progressive renal disorders can occur as a complication of chronic tophaceous gout.

COMPLICATIONS:
Renal damage- Acute Hyperuricemic nephropathy
Chronic Hyperuricemic nephropathy
Cardio vascular system- higher incidence of hyper tension and
Ischemic heart disease(8)

MANAGEMENT OF GOUT:
General management of gout primarily includes dietary restrictions. Mainly alcohol, red meat, sea foods, intake of low fat dairy products, vitamin c and coffee reduces SUA level.

The management of gout by allopathic way is mainly through anti-inflammatory drugs and analgesics. Whenthe oral medication fails, they go with intramuscular corticosteroid injection (9). However, some ofthese drugs can create dependency and side effects. So gout must be treated in a systemic way to reduce the uric acid level and avoid its complication.

HOMOEOPATHIC MANAGEMENT:
Treatment of gout has a great scope in homoeopathy than any other system of treatment. Because it is the only system of treatment that consider the exact cause of disease.“Cessateffectuscessatcausa”(10)  i.e. the disease can be removed only if the cause is removed. So while treating gout, the given medicine must be able to remove the increased uric acid level in the body. 

 Urtica urens is oneof the best remedy in treating gout. It was introduced to homoeopathy in 1856 by Fiard in, Hirschel’sArchiv.II, 162 homoeopathic pharmacopoeia of united states, 7thedition(11). Dr. Redman Coxe proved the drug by taking it 3 times per day. During the proving hehas felt the pain in arms and both ankles of rheumatic nature. Later Dr. A.R Shaw proved it and the rheumatic pain like gout was confirmed (12). These symptoms resembled gout and after that Urtica urens was started to be used in homoeopathy for treatment of gout.

In the article “Understanding gout”by Dr. RenuMadan  it is mentioned as “Urtica urens cure more cases of gout than any other medicine”(13).In “Homoeopathic medicine for relief from the pain of gout” by Dr. Sonia Ramchandani, it is said about Urtica urens as “ this remedy helps in elimination of uric acid, and she also  mentions that the patient has a tendency for gout and uric acid formation”(14). Dr. Niveditha P Rai published the article “Role of homoeopathic medicine in treating gout” on March 2016,even in whichUrtica urens is mentioned as “The remedy helps in elimination of uric acid”(15). On 15th May 2016Dr. Vikas Sharma published an article “Homoeopathic medicines for gout”. He had said Urtica urens as “The best natural homoeopathic remedy for acute gout with high uric acid level”. He also mentioned that, “Urtica urens has a brilliant power not only to lower the uric acid level, but also to restore the related symptoms and it shortens the attack of gout in very effective and safe manner”(16). In 2012 May “The gout and homoeopathy”was published by Dr. PS Mamtora and Dr. Vijay H Vyshnav. They have given this remedy for “tendency of gout and elimination of uric acid from body” (17).

In “Synoptic key of Materia Medica” Dr. Boger describes about the uric acid diathesis of this drug and he indicatesthat ,”it is useful in acute gout and uric acid intoxication”(18). In the book “Golden beads” which is a compilation of Boericke, Clark, Blackwood and Allen it is  given as “Urtica is a good remedy for acute gout, which cut short the attack”(19). “Boericke’s New manual of Materia Medica” mentions Urtica urens as it is useful in “pain in acute gout and pain in ankle and wrist”(20). In “Lotus Materia Medica”, Dr. Robin Murphy explains that , “it is useful in both acute and chronic gout”. Dr. Robin Murphy has also mentioned the saying of Dioscorides that, “if Urtica urens is eaten when boiled with periwinkles it dissolves that are to be cleansed from the body and expels by means of urine”(21). Dr. Chodhuri also has given this medicine as “cleansing agent”(22) on treatment of gout. In “Golden beads” and in the “Prescriber”, the treatment of gout by Dr. JC Burnett is mentioned as “tincture of 5 drops of Urtica urens in warm water in 2-3 hours gap can produce the urine dark loaded with uric acid”(23). Dr. JC Burnett on his experiments found the impact of Urtica urens in reducing the uric acid level in body.

In “Gout and its cure” by Dr. JC Burnett he has introduced the magic of Urtica urens. He found a great doctrine of signature of this plant. The Urtica was widely present in sewage areas and he found that plant carried off the fluid sewage. This point made him to think that it can clean the body. He concludes as “Urtica possess the power of eliminating urates and it can treat the gout in most safe manner”(24).

As the name indicates it has the ability to eliminate uric acid and there by all sewage in our blood and body will be cleaned. Just like the plant Urtica urens cleans the surrounding through absorption, the homoeopathic medicine Urtica Urens removes uric acid through urine excretion. Lower potencies and tincture are more applicable in treatment of gout.

A CASE STUDY ON GOUT TREATED WITH URTICA URENS 6C 

Name: Mr. AK      Date: 09-12-2019
Age:    30 yrs  Sex: Male
Occupation: Business
Residence: Dubai

CHIEF COMPLAINTS:

  • Patient complaints of pain in Great toe of right foot since 1 month on and off.
  • C/O Generalized weakness since 1 week.

H/O PRESENTING COMPLAINTS:
Patient complaints started as heel pain occasionally before 2 months took allopathic medication for the same but I was coming on and off. Since 1 month he is having pain in the right great toe with mild swelling of the same. Complaints <  on night, standing for long time. Patient came back from Dubai to Mangalore before 1 week after that patient feel general weakness and pain in toe increased.

PAST HISTORY: Nothing significant.

FAMILY HISTORY: Father: Hypertension Brother: Hyperuricemia

PHYSICAL GENERALS: 

  • Appetite: good 3t/ day
  • Thirst: less 1-2 l/ day
  • Desire: Non veg, Beef and Mutton.
  • Aversion: Vegetables, Potatoe
  • Bowel: Regular 1 time/ day
  • Bladder: 3-4 t/ day
  • Sleep: 11 to 5 am, sleepy during day since 1 month.

MENTAL GENERALS:

  • Likes to be with friends. 
  • Thinks that he is not healthy, thinks that he is weak.
  • Thoughts about Business.
  • Want to do things fast, hurry.
  • Anxiety about business.

SYSTEMIC EXAMINATION:

 CVS: S1 S2 heard. No murmur.

 RS: NVBS. No added sounds.

 P/A: Soft, NAD

LOCAL EXAMINATION:

  • Mild swelling and inflammation signs of Great toe right side, Tenderness present.
  • Heel: No signs of inflammation, No tenderness.

LIFE SPACE INVESTIGATION:
Patient hails from a middle socio economic family. His father was a business man and he was also interested in business from his childhood. So when ever his father is not there in the shop he used to take care of the shop. He studied till 10th was not much interested in studies. Studied up to 10th and joined with father for business purposes. He has an elder brother working in Honda showroom. After some years he got a chance to go to Dubai and he was working as hotel worker. After 1 year he started a business by his own name with the money he earned and also with his brother’s help. The business is going well but he has the anxiety about business.  In between he had not enough time to eat so he was taking whatever available. He couldn’t take care of his health and weight. Then he started with mild heel pain and followed by pain in right great toe. Later he started feeling that he is not healthy and he must take care of his health. He was explaining that he want to remove all waste from his body. But he was not ready to reduce his normal diets and cravings.

TOTALITY OF SYMPTOMS:

  • Pain in Great toe of right foot  <Night < Standing for long time
  • Likes to be with friends. 
  • Thinks that he is not healthy, thinks that he is weak.
  • Thoughts about Business.
  • Want to do things fast, hurry.
  • Anxiety about business.

PRESCRIPTION:
Patient adviced for Uric Acid analysis on same day.

09-12-2019- S. Uric Acid: 7.62mg/dl

  1. Urtica urens 6c 2p EMES weekly once
  2. No 2 pills (3-0-3)

23-12-2019

  • Pain and swelling reduced. 
  • Generals are good.
  • General weakness better.     

Rx,

  1. Urtica urens 6c 2p EMES weekly once
  2. No 2 pills (3-0-3)

27-12-2019                                                                              

  • Patient is better. No complaints of swelling or pain.
  • No c/o general weakness.
  • All Generals are good.

S. Uric Acid: 5.98mg/dl

Rx,

  1. SL 2p/ weakly once EMES
  2. No 2 pills (3-0-3)

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REFERENCE:

  1. Dr. Arup Kumar Kundu, AbhishekKundu; Textbook of Rheumatology; The Associations of Physicians of India;Chapter 39,Gout in 2017, p. 180-182.
  2. Parkodi R, Parthiban M, Rukmangatharajan S, Kanakarani P, PanchapakesaRajendranC;Clinical Spectrum Of Gout In South India, p. 61-63.
  3.  Y P Munjal,API Textbook of Medicine, 10TH edition, (Volume 2), p. 2483-2484.
  4. Dr. Arup Kumar Kundu, Textbook of Rheumatology, The Associations of Physicians of India,Chapter 98,Gout in Indian Scenario,p. 444-448.
  5. Channa Reddy H, Siddalingamurthy G; Epidemiology, Comorbidities and Clinical Features of Gout in Southern Part of India;Scholars Journal of Applied Medical Sciences; p. 3284-3288.
  6. Parle Milind, KauraSushila, SethiNeeraj; Understanding Gout Beyond Doubt; International Research Journal Of Pharmacy; p. 25-33.
  7. Sir Stanley Davidson; Davidson’s Principles & Practice of Medicine; 21stedition, Elsevier limited 2010, p. 1097-1100.
  8. K V Krishna Das, Textbook of Medicine, 5th edition, p. 729-731
  9. Dr. Rajiv RuiViegas Peres; Study of gout with miasmatic approach.
  10. Dr. Samuel Hahnemann; Organon of Medicine, 6th edition, in 1810  by B. Jain Publishers (P) Ltd.; p.8.
  11. P.N. Verma&InduVaid; Encyclopaedia of Homoeopathic Pharmacopoeia (Volume 2); by B. Jain Publishers (PVT) LTD.
  12. Hughes Dake; A Cyclopaedia Of Drug Pathogenesy (Volume4).
  13. Dr.RenuMadan; Understanding Gout (https://renumadan.com/2016/10/01/understanding-gout/) .
  14. Dr. Sonia Ramchandani; Homoeopathic Medicine for Relief from the Pain of Gout; July 1,2009 (https://vitalitymagazine.com/article/homeopathic-medicine-for-relief-from-the-pain-of-gout/) .
  15. Dr. Nivedita P Rai; Role of Homoeopathic Medicines in Treating Gout; 26 March 2016 (http://prac.to/75nt) .
  16. Dr. Vikas Sharma, MD; Homoeopathic Medicines for Gout; May 15, 2016 .
  17. Dr. P S Mamtora, Dr. Vijay H Vaishnav; Gout & Homoeopathy (http:/www.drvaishnav.com/) .
  18. C.M. Boger; A Synoptic Key of the Materia Medica; by B. Jain Publishers (P) ltd, p. 326.
  19. Boericke, Clarke, Blackwood and Allen; The Golden Beads- A compilation from leading Materia Medica, p. 462-463.
  20. William Boericke; Boericke’s New Manual of Homoeopathic Materia Medica with Repertory; 9th edition, p. 580-581.
  21. Robin Murphy, ND; Lotus Materia Medica, 3rd edition.
  22. N. M. Choudhuri,MD; A Study On Materia Medica, p. 786-787.
  23. J. H. Clarke; The Prescriber.
  24. J. Compton Burnett, M.D.; Gout and its Cure, p. 33-44.

Dr Midhun Jose
Md Part 1
Father Muller Homoeopathic Medical College, Deralakatte, Mangalore
Email: midhunrockzon123@gmail.com

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