A case of leucoderma treated with sepia

Dr Hasrha Varthini M 

ABSTRACT:
The patient named Ms.X aged 7 years presented with the complaints of whitish discoloration in dorsum of left hand since 1 month. She was treated with SEPIA 0/3 nine dose; there is improvement in her complaints and she developed itching in the dorsum of hand and again SEPIA 0/3 weekly one dose is repeated. Now, there is improvement as a whole.

INTRODUCTION:
Leucoderma is commonest.It can affect people of any age, gender, or ethnic group. It is an auto immune disorder of the skin in which certain parts of the skin begin to lose its color leading to the appearance of white patches. When the Melanin is destroyed, lost gradually or not produced then the skin loses its color and leaves white spots known as Vitiligo or Leucoderma. These white patches are irregular in appearance with an outline that is darker than the skin, they gradually increase in size.Homoeopathy has a great scope in treating such cases by selecting the suitable remedy on the basis of the symptom similarity. This is a case was effectively treated with SEPIA.

KEY WORDS: Leucoderma,SEPIA.

PATIENT AS A WHOLE

• Name- Ms. X
• Age/ Sex -7 /Female
• Religion – MUSLIM
• Occupation- Student
• Address – YYYY
• Date of case taking: 12/04/2018

PRESENTING COMPLAINTS

LOCATION	SENSATION	MODALITY	ACCOMPAINMENTS
Upper extremities Left dorsum of hand  since 1month Respiratory system since 1 day Fever since1 day	Whitish discoloration. Itching occasionally.  Cough with yellowish expectoration Watery discharge from nose     Fever      100ºF	<Bathing <perspiration <Night <Night

HISTORY OF PRESENTING ILLNESS: 

Patient’s complaints started before 1 month as whitish discoloration on dorsum of hand and near middle finger. Discoloration started as small spot and later spreads. Itching occasionally present worse during bathing and during perspiration. For this complaint he took allopathic medication but no relief. She also presented with Cough with yellowish expectoration and watery discharge from nose worse during night time. Patient also complaints of fever since 1day aggravation at night.

HISTORY OF PREVIOUS ILLNESS WITH TREATMENT ADOPTED :Had measles before 3 years – Took ayurvedic treatment.

PERSONAL HISTORY: Takes mixed diet. No addictions.

GENERAL FEATURES:

Appetite: Normal, Thirst –Normal, Sleep- Good

Stool- Regular once daily, Urine- 4-5 times/day;Sweat- perspiration profuse on scalp. Desire – Sweets, Fish, ice cream

MENTAL GENERALS:.

• Desires company
• co operative
• Easily angered and weeps easily

REACTION TO:

• Desire for cold drinks, cold food
• Desire cold season
• Aversion to covering 
• Desire for fanning
• Thermal – Hot

PHYSICAL FINDINGS:

• Anemia- Not anemic, Jaundice- not icteric, 
• Clubbing – Nil, Cyanosis – Nil, Oedema- Nil, Lymphadenopathy – Nil
• Conscious and oriented.
• Pulse –72beats/ min 
• BP: –
• Temp:      100ºF
• Respiratory rate: 19/minute
• Body weight: 21.5 kg
• Height: 125 cm
• BMI: 13.8

SYSTEMIC EXAMINATION:

RESPIRATORY SYSTEM:

Inspection: Nose: No DNS, No Hypertrophied turbinate. No Polyp.

Palpation: No warmth, No tenderness.

Auscultation: Normal vesicular breathing heard all over the lung fields.

Percussion:Normal resonance sound is heard.

CARDIOVASCULAR SYSTEM:

First and second heart sounds are heard normally in all 4 auscultatory areas.

ANALYSIS OF SYMPTOMS

COMMON SYMPTOM	UNCOMMON SYMPTOM
Whitish discolouration Itching Desires Company Cough Watery discharge	Easily angered Weeps easily Desire – Ice cream Desire for Cold drinks, Cold food Profuse sweating head Desire to fanning. Whitish discolouration on dorsum of hand and near middle finger Worse – bathing, perspiration. Whitish expectoration  Agg- night

EVALUATION OF SYMPTOMS

Mental Generals :

• Desires company
• Easily angered
• Weeps easily

Physical generals:

• Desire – Ice cream
• Desire for Cold drinks, Cold food
• Profuse sweating head
• Desire to fanning.

Particulars:

• Whitish discolouration on dorsum of hand and near middle finger
• Itching
• Worse – bathing, perspiration.
• Cough with whitish expectoration 
• Agg- night

TOTALITY OF SYMPTOMS:

• Desires company
• Easily angered
• Weeps easily
• Desire – Ice cream
• Desire for Cold drinks, Cold food
• Profuse sweating head
• Desire to fanning
• Whitish discolouration on dorsum of hand and near middle finger
• Itching
• Worse – bathing, perspiration.
• Cough with whitish expectoration 
• Agg- night

MIASMATIC ANALYSIS¹

PSORA	SYCOSIS	SYPHILIS
Cough with whitish expectoration  itching	Desire – Ice cream Desire for Cold drinks, Cold food Profuse sweating all over the body <NIGHT <EVENING	Hypo pigmentations <NIGHT <EVENING

Miasm: Psora Sycotic

PROVISIONAL DIAGNOSIS:  

Leucoderma

REPERTORIAL ANALYSIS:

• MIND –ANGER- easily
• MIND – WEEPING – anger- after
• SKIN – DISCOLOURATION – White -spots
• SKIN- ITCHING – Perspiration- during
• COUGH- LOOSE -Night
• NOSE-DISCHARGE – Watery
• EXPECTORATION – YELLOW
• FEVER- Night
• GENERALITIES – FOOD AND DRINKS – cold drinks, cold water – desire

REPERTORIAL ANALYSIS:

• CALC.CARB – 14/7
• LYC – 13/6
• CHAM – 12/6
•  SIL.- 11/6
•  BELL – 8/6
•  PULS – 8/6
•  SEP – 11/5
•  GRAPH-9/5
•  SULPH – 9/

ACUTE TOTALITY:

• COUGH – LOOSE – night
• NOSE DISCHARGE – watery
• EXPECTORATION – yellow
• FEVER – NIGHT
• GENERALITIES – FOOD AND DRINKS – cold drinks – desire

MEDICINAL SELECTED: SEPIA

BASIS OF SELECTION:

• Sweat from least excertion
• Fever towards night
• Dry cough
• Cough worse after evening
• Nasal catarrh
• Aggravation – evening,night
• Flushes of heat at intervals esp.afternoon,evening[Clarke]
• Perspire too easily 
• Itching in different parts 
• Itching with eruptions [Clarke]

METHODS ADAPTED:

FIRST PRESCRIPTION:  8-04-2016

R_X

1. SEPIA0/3 9DOSE, (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose) (TDS X 3 DAYS)
2. SG (3 – 0 – 3) X 7 DAYS
3. SD (1 – 0 – 1) X 7 DAYS

BASIS OF SELECTION OF POTENCY:

                       Potency is selected according to the susceptibility of the patient.

CRITERIA	CRITERIAS	SUSCEPTIBILITY
AGE	7	HIGH
SEX	FEMALE	LOW[FEMALE]
SEVERITY OF DISEASE	MODERATE	MODERATE
MODERATE/DISTURBED SLEEP	GOOD	HIGH

FOLLOW UPS:

DATE	FOLLOW UP	MEDICINE PRESCRIBED
09/4/2018	Whitish discolouration with itching on left hand better than before Fever is reduced Cough is better wih whitish expectoration Agg – Night Coryza better Generals are good. O/E : Chest -clear	RX SEPIA 0/3 1DOSE  no.30 sized globule in 1grain of sugar of milk – Dry dose  (M) X I DAY SL / 6 DOSES  (M) X 6 DAYS SG ( 3 – 0 – 3 ) X 7 DAYS SD ( 1 – 0 – 1 ) X 7 DAY
18/4/2018	Whitish discolouration on left hand persist as same Itching is reduced Cough is reduced, but persists Agg – Night Nose block Agg – Night Early morning Generals are good.	RX SEPIA 0/3 1DOSE  no.30 sized globule in 1grain of sugar of milk – Dry dose  (M) X I DAY SL / 6 DOSES (M) X 6 DAYS SG ( 3 – 0 – 3 ) X 7 DAYS SD ( 1 – 0 – 1 ) X 7 DAYS
25/04/2018	Whitish discolouration on left hand persist as same Itching is reduced Cough is reduced, but persists Agg – Night Nose bock is reduced Generals are good. O/E : Chest -clear	RX SEPIA 0/3 1DOSE  no.30 sized globule in 1grain of sugar of milk – Dry dose  (M) X I DAY SL / 6 DOSES (M) X 6 DAYS SG ( 3 – 0 – 3 ) X 7 DAYS SD ( 1 – 0 – 1 ) X 7 DAYS
04/05/2018	Whitish discolouration on left hand persist as same Itching is reduced Cough is reduced, but persists Agg – Night Nose block is reduced Generals: good Chest: clear	RX SEPIA 0/3 1DOSE no.30 sized globule in 1grain of sugar of milk – Dry dose (M) X I DAY SL / 6 DOSES (M) X 6 DAYS SG (3 – 0 – 3) X 7 DAYS SD (1 – 0 – 1) X 7 DAYS
11/05/2018	Whitish discolouration on left hand persist as same Itching In left dorsal aspect of hand Generals: Good Chest: clear	RX SEPIA 0/3 1DOSE no.30 sized globule in 1grain of sugar of milk – Dry dose (M) X I DAY SL / 6 DOSES (M) X 6 DAYS SG (3 – 0 – 3) X 7 DAYS SD (1 – 0 – 1) X 7 DAYS
18/05/2018	Whitish discolouration on left hand is reduced  Small eruptions in the back of arm and along elbow joint in both upper Extremites Itching In left dorsal aspect of hand is reduced Generals: Good Chest: clear	RX SEPIA 0/3/ 1DOSE  no.30 sized globule in 1grain of sugar of milk – Dry dose  (M) X I DAY SL / 6 DOSES (M) X 6 DAYS SG (3 – 0 – 3) X 7 DAYS SD (1 – 0 – 1) X 7 DAYS
30.05.2018	Whitish discolouration on left hand persist as same Itching In left dorsal aspect of hand is reduced Small eruptions in the back of arm and along elbow joint is better. Generals:  Appetite: reduced Others: Good Chest: clear	RX SEPIA 0/3 1DOSE  no.30 sized globule in 1grain of sugar of milk – Dry dose  (M) X I DAY SL / 6 DOSES (M) X 6 DAYS SG (3 – 0 – 3) X 7 DAYS SD (1 – 0 – 1) X 7 DAYS
20.06.2018	Whitish discolouration on left hand persist is reduced Small eruptions in the back of arm and along elbow joint is better Itching is reduced Generals: Good Chest: clear	RX SEPIA 0/3 1DOSE  no.30 sized globule in 1grain of sugar of milk – Dry dose  (M) X I DAY SL / 6 DOSES (M) X 6 DAYS SG (3 – 0 – 3) X 7 DAYS SD (1 – 0 – 1) X 7 DAYS
06.07.2018	Whitish discolouration is reduced  Small eruptions in the back of arm and along elbow joint is better Itching is reduced Generals: Good	RX SEPIA 0/3 1DOSE  no.30 sized globule in 1grain of sugar of milk – Dry dose  (M) X I DAY SL / 6 DOSES (M) X 6 DAYS SG (3 – 0 – 3) X 7 DAYS SD (1 – 0 – 1) X 7 DAYS
08.09.2018	Watery coryza since 3 days Agg:Early morning <evening <cold exposure Nose block  < morning Whitish discolouration on left hand persist as same Small eruptions in the back of arm and along elbow joint is better Generals: Good	RX SEPIA 0/3 1DOSE  no.30 sized globule in 1grain of sugar of milk – Dry dose  (M) X I DAY SL / 6 DOSES (M) X 6 DAYS SG (3 – 0 – 3) X 7 DAYS SD (1 – 0 – 1) X 7 DAYS
10.08.2018	Whitish discolouration on left hand persist as same Eruptions is better Itching is reduced Cough is reduced Generals: Good	RX SEPIA 0/3 1DOSE  no.30 sized globule in 1grain of sugar of milk – Dry dose  (M) X I DAY SL / 6 DOSES (M) X 6 DAYS SG (3 – 0 – 3) X 7 DAYS SD (1 – 0 – 1) X 7 DAYS

PHILOSOPHY OF PRESCRIPTION:

DISCUSSION:

Repetition of dose:

APHORISM 247 5^TH EDITION⁶
Under these conditions, the smallest doses of the best selected homoeopathic medicines may be repeated with the best, often incredible results, at the interval of fourteen, twelve, ten, eight, seven days, and where rapidity is requisite, in chronic diseases resembling cases of acute diseases, at still shorter intervals, but in acute diseases, at very much shorter periods – every twenty four, twelve, eight, four hours, in the very acutest every hour, up to as often as every five minutes in every case in proportion to the more or less rapid course of the disease and of the action of the medicine employed, as is more distinctly explained in the last note.

APHORISM 248:⁷ § 248 Fifth Edition:
The dose of the same medicine may be repeated several times according to circumstances, but only so long as until either recovery ensues, or the same remedy ceases to do good and the rest of the disease, presenting a different group of symptoms, demands a different homoeopathic remedy.

§ 248 Sixth Edition
For this purpose, we potentize a new the medicinal solution1 (with perhaps 8, 10, 12 succussions) from which we give the patient one or (increasingly) several teaspoonful doses, in long lasting diseases daily or every second day, in acute diseases every two to six hours and in very urgent cases every hour or oftener. Thus in chronic diseases, every correctly chosen homoeopathic medicine, even those whose action is of long duration, may be repeated daily for months with ever increasing success. If the solution is used up (in seven to fifteen days) it is necessary to add to the next solution of the same medicine if still indicated one or (though rarely) several pellets of a higher potency with which we continue so long as the patient experiences continued improvement without encountering one or another complaint that he never had before in his life. For if this happens, if the balance of the disease appears in a group of altered symptoms then another, one more homoeopathically related medicine must be chosen in place of the last and administered in the same repeated doses, mindful, however, of modifying the solution of every dose with thorough vigorous succussions, thus changing its degree of potency and increasing it somewhat. On the other hand, should there appear during almost daily repetition of the well indicated homoeopathic remedy, towards the end of the treatment of a chronic disease, so-called (§ 161) homoeopathic aggravations by which the balance of the morbid symptoms seem to again increase somewhat (the medicinal disease, similar to the original, now alone persistently manifests itself). The doses in that case must then be reduced still further and repeated in longer intervals and possibly stopped several days, in order to see if the convalescence need no further medicinal aid. The apparent symptoms (Schein – Symptome) caused by the excess of the homoeopathic medicine will soon disappear and leave undisturbed health in its wake. If only a small vial say a dram of dilute alcohol is used in the treatment, in which is contained and dissolved through succussion one globule of the medicine which is to be used by olfaction every two, three or four days, this also must be thoroughly succussed eight to ten times before each olfaction

Why LM Potency is needed in this case?

246 Aphorisms: On the other hand, the slowly progressive amelioration consequent on a very minute dose, whose selection has been accurately homoeopathic, when it has met with no hindrance to the duration of its action, sometimes accomplishes all the good the remedy in question is capable from its nature of performing in a given case, in periods of forty, fifty or a hundred days. This is, however, but rarely the case; and besides, it must be a matter of great importance to the physician as well as to the patient that were it possible, this period should be diminished to one-half, one-quarter, and even still less, so that a much more rapid cure might be obtained. And this may be very happily affected, as recent and oft-repeated observations have shown, under three conditions: firstly, if the medicine selected with the utmost care was perfectly homoeopathic; secondly, if it was given in the minutest dose, so as to produce the least possible excitation of the vital force, and yet sufficient to effect the necessary change in it; and thirdly, if this minutest yet powerful dose of the best selected medicine be repeated at suitable intervals,¹ which experience shall have pronounced to be the best adapted for accelerating the cure to the utmost extent, yet without the vital force, which it is sought to influence to the production of a similar medicinal disease, being able to feel itself excited and roused to adverse reactions.

$ 246 Fn^{4 :} [“What I said in the fifth edition of the Organon⁷, in a long note to this paragraph in order to prevent these undesirable reactions of the vital energy, was all that the experience I then had justified. But during the last four or five years, however, all these difficulties are wholly solved by my new altered but perfected method. The same carefully selected medicine may now be given daily and for months, if necessary in this way, namely, after the lower degree of potency has been used for one or two weeks in the treatement of chronic disease, advance is made in the same way to higher degrees, (beginning according to the new dynamization method, taught herewith with the use of the lowest degrees)”

§ 247 Sixth Edition :It is impractical to repeat the same unchanged dose of a remedy once, not to mention its frequent repetition (and at short intervals in order not to delay the cure). The vital principle does not accept such unchanged doses without resistance, that is, without other symptoms of the medicine to manifest themselves than those similar to the disease to be cured, because the former dose has already accomplished the expected change in the vital principle and a second dynamically wholly similar, unchanged dose of the same medicine no longer finds, therefore, the same conditions of the vital force. The patient may indeed be made sick in another way by receiving other such unchanged doses, even sicker than he was, for now only those symptoms of the given remedy remain active which were not homoeopathic to the original disease, hence no step towards cure can follow, only a true aggravation of the condition of the patient. But if the succeeding dose is changed slightly every time, namely potentized somewhat higher (§§ 269-270) then the vital principle may be altered without difficulty by the same medicine (the sensation of natural disease diminishing) and thus the cure brought nearer.1

1 We ought not even with the best chosen homoeopathic medicine, for instance one pellet of the same potency that was beneficial at first, to let the patient have a second or third dose, taken dry. In the same way, if the medicine was dissolved in water and the first dose proved beneficial, a second or third and even smaller dose from the bottle standing undisturbed, even in intervals of a few days, would prove no longer beneficial, even though the original preparation had been potentized with ten succussions or as I suggested later with but two succussions in order to obviate this disadvantage and this according to above reasons. But through modification of every dose in its dynamiztion degree, as I herewith teach, there exists no offence, even if the doses be repeated more frequently, even if the medicine be ever so highly potentized with ever so many succussions. It almost seems as if the best selected homoeopathic remedy could best extract the morbid disorder from the vital force and in chronic disease to extinguish the same only if applied in several different forms.

CASE SUMMARY
The patient named Ms.X aged 7 years presented with the complaints of whitish discoloration in dorsum of left hand since 1 month. she also complaints of cough with watery discharge since 2 days. She was treated with SEPIA 0/3 nine dose; there is improvement in her complaints and she developed itching in the dorsum of hand and again SEPIA 0/3 weekly one dose is repeated. There is also recurrent attack of cold but now the severity and recurrenceare reduced. Now, there is improvement as a whole.

CONCULSION:
Thus, from this case we studied about the SEPIA’s action on dermal and respiratory affection and also about the role of LM potency, its action and is uses is studied from this case and when it has to be repeated is described in this case.

REFERENCES

1. Boericke William. Pocket manual of Homoeopathic material medica and Repertory.New Delhi : B. Jain Publishers (P) Ltd ;2015.p.514,515
2. Clarke JH.A Dictionary of practical Materia medica.
3. Phatak S.R Materia medica of Homoeopathic medicine,.New Delhi: B. Jain Publishers (P) Ltd.p.589,560
4. The guiding symptoms of our Materia medica volume 4,New Delhi: B. Jain Publishers (P) Ltd; 2015.p.no 684-686.
5. Banerjea Kumar Subrata. Miasmatic Prescribing. Extremites. New Delhi: B. Jain Publishers (P) Ltd; 2015.
6. Hahnemann Samuel. Organon of Medicine. Aphorism. 5^th& 6^th edition. New Delhi: B. Jain Publishers (P) Ltd; 2005. p.126.
7. Hahnemann Samuel. Organon of Medicine. Aphorism. 5^th& 6^th edition. New Delhi: B. Jain Publishers (P) Ltd; 2005. p.127.