Differentiation of first grade remedies of dysmenorrhea from Boericke’s repertory

Dr Rathna Priyadarshini

Abstract
Repertory is an index to Materia medica, it is a useful tool where in we find symptoms in the form of rubrics and a group of remedies associated with it.

Dysmenorrhea means cramping pain accompanying menstruation. But a more realistic and practical definition includes painful menstruation of significant magnitude so as to incapacitate day to day activities. It is one of the commonest gynecological problem in women of all ages and races. Though the Dysmenorrhea is not a life threatening condition but it can cause considerable burden on the quality of life of female adolescents or women.

In Boericke’s repertory we find direct rubric for Dysmenorrhea in the chapter female genital organs with first and second grade remedies. It gives an idea about the close running medicines indicated for Dysmenorrhea. We need to differentiate remedies given under the rubrics with our Materia Medica knowledge and experience to arrive at a right prescription.

In this article an attempt has been made to differentiate and understand first grade remedies given under the rubric ‘Dysmenorrhea’ in Boericke Repertory, which is  useful in clinical practice.

Keywords– Dysmenorrhea, Boericke repertory.

Introduction –Dysmenorrhea

Types

Primary dysmenorrhea -refers to the one that is not associated with any identifiable pelvic pathology caused due to increased myometrial contraction, Prostaglandin production.

Secondary dysmenorrhea -refers to the one associated with any pelvic pathology i.e PID, Endometriosis, Adenomyosis, Fibroids, Etc.

Cause of pain

• Psychosomatic factors – tension and anxiety during adolescence.
• Abnormal anatomy and functional aspect of myometrium

Uterine myometrial hyperactivity.

Outer myometrium and subendometrial myometrium are different structurally and functionally.

Dysperistalsis and hyperactivity of uterine Junctional zone are some important mechanisms.

• Imbalance in the ANS of uterine muscle

The relief of pain following Normal Vaginal Delivery /dilatation of cervix may be explained by the damage of the adrenergic neurons which fail to regenerate.

• Role of prostaglandins

In ovulatory cycles –secretory endometrium secretes Prostaglandin [PGF2 & PGE2] under the action of progesterone.

Prostaglandins are released with maximum production during shedding of endometrium.

PGF2 is a strong vasoconstrictor which causes ischemia of the myometrium –Leading to increased myometrial contraction.

• Role of vasopressin

Increased in Primary Dysmenorrhea which explains persistence of pain in cases even treated with anti-prostaglandins.

It increases prostaglandins synthesis and myometrial activity leading to pain.

• Endothelins

Causes myometrial smooth muscle contractions especially in junctional zone.

Also increases prostaglandins synthesis leading to pain.

• Platelet activating factor –High concentration in Dysmenorrhea.

Leucotrienes and platelet activating factor are vasoconstrictors causing myometrial contraction and pain.

Diagnostic features of Primary Dysmenorrhea

• Crampy suprapubic pain that begins between a few hours before and a few hours after the onset of menstrual flow.
• Pain is characteristically colicky or crampy or spasmodic.
• Location of pain: midline of lower abdomen, extends to both quadrants, lumbar region and thigh.
• Associated symptoms are diarrhea, nausea and vomiting, fatigue, light headedness, headache, dizziness, rarely syncope and fever.
• Normal findings in USG abdomen and pelvis.

Diagnostic features of Secondary Dysmenorrhea

• The pain is dull, situated in the back and in front without any radiation.
• Appears 3-5 days before to the period and relieves with the start of bleeding.
• The onset and duration depends on the pathology causing the pain.
• So systemic discomfort unlike Primary Dysmenorrhea.
• USG- shows pelvic pathology.

First grade remedies under the rubric Dysmenorrhea in Boreicke’s repertory

• Belladonna
• Borax veneta
• Cactus grandiflorus
• Caulophyllum
• Chamomilla
• Cimicifuga racemosa
• Cocculus indicus
• Coffea cruda
• Collinsinia canadensis
• Gelsemium sempervirens
• Gnaphalium
• Guaiacum
• Hamamelis virginiana
• Kalium Permanganatum
• Apoline
• Macrotinum
• Magnesium carbonicum
• Magnesium phosphoricum
• Pulsatilla nuttaliana
• Secale cornutum
• Sanicula aqua
• Veratrum album
• Viburnum opulus
• Xantoxylum fraxineum

1. BELLADONA

• Menses too early offensive, profuse, bright red & hot, with bearing down sensation. Pains usually in short attacks, comes suddenly & ceases suddenly. pain in the ovaries with the appearance of menses.
• Suited to Women with light hair & blue eyes, plethoric, lymphatic constitutions with congested red face, throbbing of brain & carotids.
• Violent delirium, <touch, noise, sun, least jar.
• > rest, standing & sitting erect, pressure.

2. BORAX VENETA

• Indicated for for membranous dysmenorrhea.
• Violent forms of membranous dysmenorrhea when there is violent labour like pains before and during the flow and it seems as if uterus would expel itself from vagina.
• Flow starts slightly but the same violent pains keeps on until the expulsion of the membrane.
• Menses too early profuse with colicky pain.
• During menses-throbbing in head, griping in abdomen, sweat after midnight.
• Pain in stomach extending to back >pressure.
• Extreme anxiety and dread of downward motion

3. CACTUS

• Indicated in dysmenorrhea with pulsating pain in uterus and ovaries. Menses early dark pitch like which cease on lying down.
• Suited when an young plethoric, vigorous women comes down violently with congestion of uterus at menstrual period.
• Before the flow starts -there is violent spasms as if the tape were tied around the congested uterus.
• Constrictive of uterus or spasmodic pains.

4. CAULOPHYLLUM

• Pains intermittent, paroxysmal, spasmodic across lower abdomen extending to groins with little flow, nausea and vomiting.
• Violent Pains changing place every few minutes with great exhaustion and general debility.
• Before menses- pain in small of back, great aching and soreness of lower limb, bad breath, bitter taste chilliness.
• Chorea, hysteria at puberty during establishment of menstrual function.

5. CHAMOMILLA

• Indicated in membranous dysmenorrhea specially at puberty.
• The menstrual flow is copious black clotted, offensive, violent labour like cramping pains in the uterus, clutching and griping, ameliorated by heat.
• Excessive menstruation with pain through from back to front, attacks of syncope, coldness of limbs with much thirst.
• Oversensitive to pain, dysmenorrhea from anger or emotions.

6. CIMICIFUGA RACEMOSE

• Rheumatic dysmenorrhea.
• Useful in rheumatic nervous subjects with ovarian irritation, uterine cramps, and heavy limbs.
• Pain immediately before menses.
• Menses profuse dark coagulated, offensive with backache, nervousness, always irregular. Pain in ovarian region shoots upward and down anterior surface of thighs.
• Pains like electric shocks here and there, across pelvis from hip to hip, with chorea, hysteria, mania. Increase of mental symptoms during menses.
• <during menses-The more profuse the flow, the greater the suffering
• >warmth, eating.

7. COCCULUS INDICUS

• Dysmenorrhea with profuse dark menses of coagulated blood.
• Too early menses and lasts long, clotted with spasmodic colic.
• Indicated in women, prostrated from grief, and from anxiety, prolong loss of sleep.
• menses come soon and are copious and prolonged,
• Purulent, gushing leucorrhea between menses like washings of meat.
• Weakness during menses, scarely able to stand.

8. COFFEA CRUDA

• Dysmenorrhea, large clots of black blood.
• Menses too early and long lasting.
• Pains are felt intensely, seem almost insupportable driving patient to despair tossing about in anguish.
• Toothache during menses.

9. COLLINSONIA CANADENSIS

• Membranous dysmenorrhea with constipation, Haemorrhoids and pruritis of vulva.
• Sensation of swelling of labia and of clitoris.
• Cold feeling in the thighs after menstruation.
• Swelling and darkness of genitals, pain on sitting down.

10. GELSEMIUM SEMPERVIRENS

• Indicated for children, young people especially women of a nervous hysterical temperament.
• Dysmenorrhea with scanty flow, menses retarted.
• Pain extends to back and hip >bending forward, open air, when thinking of the ailments.
• Sensation as if uterus were squeezed.
• Aphonia and sore throat during menses.

11. GNAPHALIUM

• Dysmenorrhea with weight and fullness in the pelvis.
• Menses are scanty and very painful the first day.

12. GUAIACUM

• Membranous dysmenorrhea.

13. HAMAMELIS VIRGINIANA

• Dysmenorrhea with severe pains through the lumbar and hypogastric region and down the legs.
• Menses dark profuse with soreness in abdomen.
• Intermenstrual pain, bearing down pain in back,
• Metrorrhagia occurring between menstrual periods.

14. MACROTINUM

• Menses scanty and dark, clotted, afterwards increased in quantity,
• Suppression of menses for six weeks.
• Pain not > for several hours after the flow begun.
• Distinctive feature- all symptoms > by the onset of menstrual flow other than the dysmenorrhea pains.

15. MAGNESIUM CARBONICUM

• Menses with labor like pains, cutting colic, backache, weakness, chilliness.
• Sore throat, nasal stoppage before menses appear.
• Menses too late and scanty, thick, dark, like pitch difficult to wash.
• Menses flow only in sleep, more profuse at night or while lying down,  cease when walking, by pressure on abdomen and on stooping.
• Falls down in a dead faint at each menstruation period.

16. MAGNESIUM PHOSPHORICUM

• Membranous and congestive dysmenorrhea with great weakness, sore bruished feeling through abdomen.
• Menstrual colic pain preceeds flow, cutting drawing, pressing, cramping darting like lightening, shooting.
• Menses too early, dark stringy <before flow.
• >heat, pressure, by flow, bending double.

17. PULSATILLA

• Indicated in women inclined to be fleshy, with scanty and protracted menstruation and thirstless.
• Menses too late, scanty, thick, dark, scanty, clotted, changeable, intermittent.
• Pains rapidly shifting, appear suddenly leaves gradually.
• Flow intermits with pain, nausea, chilliness, downward pressure, pain in back, tired feeling. Better by walking in the cool open air.
• Diarrhoea during and after menses.
• Mild gentle yielding disposition cries at anything, can hardly give her symptoms on account of weeping.

18. SECALE CORNUTUM

• Menstrual colic with coldness and intolerance of heat in feeble, cachetic women with excessive thirst.
• Menses irregular, copious, dark continuous oozing of watery blood until next period with violent spasms, labor like pains in abdomen, especially during a slight movement.

19. SANICULA AQUA

• Bearing down, as if contents of pelvis would escape, desire to support parts.
• Menses irregular, always late, come on with griding or dilating pain in lower abdomen in lower abdomen, with soreness of womb, pain in back >when flow starts.
• Cramp like pain in uterine region before menses ceasing after flow.
• <walking, motion, jar >rest lying down.

20. VERATRUM ALBUM

• Dysmenorrhea with coldness, vomiting, prolapse, cold sweat, exhausting diarrhoea, pain in uterus and lumbar region before and during menses.
• Weakness can scarely stand for two days at each menstrual period.
• Menses too early, profuse, exhausting with thirst for large quantities of cold water.
• Sexual mania precedes menses.
• Before menses- headache in morning with nausea, humming in ears, burning thirst, and pain in all limbs, nymphomania and cholera like symptoms.
• End of menses- grinding teeth, bluish color of face.

21. VIBURNUM OPULUS

• Spasmodic and membranous dysmenorrhea.
• Pain as if breath would leave her body and heart would cease to beat.
• Menses too late, scanty, lasting a few hours, offensive in odour, with crampy pains, cramps extend down thighs.
• Sudden bearing down pains in uterus and hypogastrium before menses.
• During menses-heavy aching in sacral region and pubes with pain in anterior muscles of thighs.
• Ovarian region feels heavy and congested.
• Cramps in calves always between menses < just before menses, lying down >movements.

22. XANTOXYLUM FRAXINEUM

• Neuralgic Dysmenorrhea with neuralgic headache.
• Menses too early with agonising pains, driving patient almost distracted.
• Ovarian neuralgia with pain in loins and lower abdomen worse left side extending down the thigh along genitocrural nerve, pain in back and down legs.
• Menses thick, almost black.
• Leucorrhoea at the time of menses.
• Neurasthenic patients who are thin, emaciated, poor assimilation with insomnia and occipital headache.

CONCLUSION
In order to put the Repertories at best use, we must understand how the remedies under a same rubric differ.

This was an attempt to understand and differentiate the 22 first grade remedies given under the rubric Dysmenorrhea in Boericke repertory using Materia medica.

REFERENCES

1. Lecture On Homoeopathic Materia Medica By Dr J T Kent.
2. New Manual Of Homoeopathic Materia Medica And Repertory By Dr William Boericke.
3. A Dictionary Of Practical Materia Medica By Dr J H Clarke.
4. Keynotes And Characteristics With Comparison With Bowel Nosodes By Dr H C Allen.
5. Materia Medica Of Homoeopathic Medicines By Dr S R Phatak.
6. Leaders In Homoeopathic Therapeutics By Dr E B Nash.

Dr Rathna Priyadarshini
MD PART-II
Department of Repertory
Under The Guidance Of Dr Anusuya M Akareddy
Govt Homoeopathic Medical College And Hospital Bengaluru.