Homoeopathic approach for the treatment of diarrhoea in children

Dr Supriya Halder

How to implement Information Technology in PG education & learning in Homoeopathy

INTRODUCTION –
Diarrhoea is the passage of liquids or watery stool more than three times a day. However, it is the recent change in the consistency of stools rather, than the number of stools that is the more important feature.

Persistent diarrhoea is defined as diarrhoea of presumed infectious origin that begins acutely & lasts for 14 days or more. Persistent diarrhoea occurs rarely in infants below 6 months who are exclusively breastfed. A breastfed infant could normally be passing several soft or mushy stools each day. In such cases the change in character of stool will be important.

And the syndrome of dysentery is characterized by the presence of blood & pus in the stools, abdominal cramp & fever.

The two main risks of diarrhoea are malnutrition & death. Dehydration is the most common cause of death due to diarrhoea. A significant number of deaths occur as a result of malnutrition consequent to a series of diarrhoea.

EPIDEMIOLOGY –
Diarrhoeal disease is the second leading cause of death in children under five years old. It is both preventable & treatable. Each year diarrhoea kills around 525000 children under five. A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation & hygiene. Globally there are nearly 1.7 billion cases of childhood diarrhoeal disease every year.

CAUSES 
Most infectious diarrhoeas are caused by viruses that tend to be more common in summer but can come at along any time.

Overall in India, rotavirus & enterotoxigenic E. coli are the most common cause of acute diarrhoeal disease of infants.

Shigella & Salmonella, Campylobacto jejuni, Yersenia enterocolitica, Aeromonas hydrophilia etc. are isolated bacterial pathogens of childhood diarrhoea. Shigella accounts for majority of cases of dysentery. Also E. histolytica accounts for nearly five percent of dysentery.

Giardia lamblia,cryptosporidium are the parasite rarely causes acute diarrhoea.

Food poisoing, food allergy etc. can also cause diarrhoea in kids. Sometime there are severe infantile diarrhoea may occur during dentition period, just after vaccination, during fever etc.

MANAGEMENT 
Breastfeeding should be continued during Infantile Diarrhoea. If only animal milk must be given, replace it with curds or a lactose-free milk formula. If required, cooked rice can be mixed with milk/curd or dalia. 

And to prevent dehydration & nutritional damage & to reduce duration & severity of diarrhoeal episode, Oral rehydration therapy which include solution made from sugar & salt/ food based solution or ORS is provided along with medicine.

As supplementary at least, provide vitamin A (as a single large dose) & zinc as these have been shown to effect recovery from persistent diarrhoea.

HOMOEOPATHIC THERAPEUTICS 
Nevertheless homoeopathic prescription is based on individualisation i.e. it cannot be prescribed successfully by some specific remedy although some of indications of different drugs are given below from Borick’s Materia Medica, Allen’s keynote. We must prescribe on the basis of totality of symptoms, there are some important drugs with 

1. Diarrhoea, Milk after 

• Children who cannot bear milk in any form e.g. mother’s/ cow milk; and results in undigested thin greenish stool proceeded by excessive gripping pain in abdomen with tenesmus, followed by great weakness, prostration & sleepiness. Complete absence of thirst in idiotic children, incapacity to think, confused who is very restless & irritable with well-marked linea nasalis.      – Aethusa cynapium                                                                                          

• Involuntary foetid sour diarrhoea with ravenous appetite < at evening. Milk sours on stomach & is either thrown up/ passes downward in white curded lumps. Grey clay like frothy stool with great thirst at night in flabby child with longing for egg, open fontanelles, head sweats so as wet pillow and take cold readily in consequence.                                      – Calcarea carb                                   
• Green, slimy, hot, spluttering diarrhoea with foetid flatus nearly every hour in anaemic children who are peevish, flabby, have cold extremities & feeble digestion with tendency to perspiration & glandular swelling who wants to nurse all the time and child craving for bacon, ham, salted & smoked meat.                                                                       – Calcarea phos
• Milk passes undigested in nursing child who had sour smell of the whole body. Stool green, watery, frothy like a frog- pond’s scum proceeded by gripping colicky pain, very much sour smelling & often with curds of milk. Great straining during stool with tenesmus, during which child does not want to be touched. Profuse night sweat with extreme & rapid emaciation. Child of irritable disposition & nervous temperament with inordinate craving for meat.             Magnesia carb

Sudden call to stool, escapes with haste & noise. Diarrhoea from milk, yellow substance like pulp of orange in discharge. Anaemic child had very weak digestion, caused by slightest error of diet & aversion to milk.                                                                                 – Natrum carb

From boiled milk exhausting diarrhoea, faintness during or after stool with sleepiness. Great dryness of mouth but still thirstlessness. Stool offensive, copious < at night, summer-heat, cold, cold drink, damp weather. Stool is soft yet is unable to expel it, even with long straining in children of nervous, hysterical temperament.                                            – Nux moschata

Green or sour smelling diarrhoea of children during lactation; expelled suddenly & the whole of it once. Infantile diarrhoea from taking boiled milk, almost constant oozing from bowels with rapid exhaustion. Children have open fontanelees & prolapse ani.                       – Sepia

The discharges are slimy, brown, green/ white particularly in children of delicate parents after milk indigestion; often marked with streaks of blood. Redness around anus with burning in palm, sole & great aversion to being washed, great desire for sweets, drink much & eat little. Sulphur

1. Dentitional diarrhoea 

• Thin, green, dysenteric stool in lumps like chalk, shuddering during stool with stinging pain in rectum especially during dentition. Dryness of mouth & aversion to water, sour smell of the stool with great tenesmus.becomes angry when refused or when offered, petulantly rejects it. Great thirst with hot sticky sweat on forehead. Child moaning in sleep. Milk thrown up cheesy < towards evening.                      – Chammomila
• Diarrhoea in nursing infants during painful dentition, very offensive, dark brown, bloody/ green stool with nausea, dry skin & exhaustion etc. in old looking children who have wrinkled & scrofulous affection with rapid emaciation.   – Kreosotum
• In difficult dentition long standing painless diarrhoea in early morning continues through forenoon, followed by natural stool in evening; along with sinking sensation in abdomen/ rectum. While being bathed or washed of dirty water soaking napkin through. Green, watery, foetid, profuse, gushing stool each seeming to drain the patient dry but soon he is full again. Chalk-like, jelly-like, undigested, yellow meal like sediment along with violent cramp of the feet, calves, thigh. Thirst of large quantity cold water. Prolapses ani after each stool from great weakness of rectum. Child lies upon the mother’s lap or on pillow with half closed eyes, constantly moaning & rolling his head side to side.                                – Podophyllinum
• Brown, pasty, sour smelling stool during dentition with shivering & tenesmus, burning in anus. Before stool unsuccessful desire to urinate. Child smells sour even after washing or bathing, milk tastes bitter & the baby rejects the breast with vomiting & great debility. Sweat on hairy scalp, constant & profuse; cold sweat especially about mouth & nose. Desire for various kinds of food, but soon tries of all. Colic with every sour stool < uncovering an arm/ leg, standing not > by stool. Even ineffectual urging to evacuate altered fecal stool. Impatient & vehement; desire many things & cries.  – Rheum
• Other drugs are – Aethusa, Calc. carb, Calc. phos, Hellaborus, Mag carb, Nux mos, Psorium.

1. Diarrhoea after suppressed eruption 

• Green mucus stool alter with constipation especially after measles, along with pain in navel. During & after stool burning & smarting in rectum. Offensive sweat of feat in those children who have body large & fat but legs too thin.                                                    – Ammon mur
• Watery greenish, yellowish, slimy, bloody, mucoid stool, involuntary passed with every motion, as if anus was wide open. Offensive & painless diarrhoea in eruptive disease/ especially if eruption suppressed. Stool preceded by much rumbling of flatus & sudden darting pain in rectum with great urging followed by rawness in anus. No appetite, no thirst along with fiery red tongue, urine frequent, scanty/ suppressed, strangury.                     – Apis mel
• Putrid diarrhoea, like dirty water of undigested food, smelling like old cheese < in morning, moving; acrid & soreness of anus. Dryness of mouth, tongue, throat with excessive thirst. Desire things immediately which are not to be had, or which when offered are refused. Children dislike to be carried, or to be raised.       –Bryonia alb                                           
• Suppressed eruption often causes stool brown, fluid, mixed with undigested substances & of intolerable odour which excoriating anus; followed by great but transient prostration. Very frequent & small stool with eruption on skin from which oozes a gelatinous fluid. Children impudent, teasing, laugh at reprimand.   – Graphities                                                           
• Clay- coloured, sour, soft, white undigested foetid stool < after eating drinking cold things. Child has a so thin, brown faecal mixed with hard lump < after meal, cold food, especially after supressed eruption (after scabies especially). Ineffectual urging before stool. Baby cries all day, sleep all night. Irritable & unmanageable children, weak, emaciated with well-developed head & puny, sickly bodies. Canine hunger > after little eating, cold feet.                              – Lycopodium
• Diarrhoea sudden, imperative, stool watery, dark-brown, involuntary, foetid smells like carrion, great weakness, debility < 1- 4A.M. Dirty, sallow, greasy skin with developed eruption on chest & forehead & body has a fithy smell even after bath. Child is good, plays all day, restless, troublesome, and screaming all night. Profuse perspiration after acute diseases with relief of all suffering.                                                                                    – Psorinum
• Other medicines are – Sulphur, Ant- tart.

1. Diarrhoea, vaccination after –

• Watery slimy, bloody/ offensive stool preceded by spasmodic colic & much flatus. Child will not be touched without whining. Coated pasty, thick white tongue with red edges with extraordinary craving for apples & thirst for cold water. Cold blue pale face covered with cold sweat.                                                                       – Antim tart
• Diarrhoea of cadaverous odour. Child very much emaciated by continuance of diarrhoea, it nurses well, but the food passes through it undigested, loss of appetite, open fontanelees, intolerable sour, carrion-like odour of feet, with perspiration & great thirst. Children are obstinate, headstrong, cry when spoken kindly to; aversion to milk, refuse to nurse.   – Silicea
• Another medicine is – Thuja.
• Diarrhoea during fever –
• Very offensive, thin, dark, bloody stool day & night with soreness of abdomen in low septic fever. The child can swallow liquids only least solid foods gags, foetid breath. Tongue feels burned, yellowish-brown, edges red & shining. Prostration more profound than severity of attacks justifies.          – Baptisia                                                                                          
• Black thin offensive stool like coffee-ground with craving for sugar & aversion to meat in low septic state and intolerance of clothing about epigastrium.                       – Crotalus horridus
• Some rubrics in Kent repertory regarding diarrhoea during fever–
• Hectic fever during – Aesculus
• Intermittent fever during – Cina, Rhustox, Ars., Chin. ars., Cocc., Conium, Gel., Puls., Thuja.
• Pernicious fever during – Camph., Cupr., Pyrogen.
• Typhoid fever during – Hyos, Phos etc.

1. Diarrhoea from food poisoning –

• Lumpy watery jelly-like stool which passes without effort immediately after eating, drinking, almost unnoticed with soreness in rectum after stool. Hungry during stool. Before stool rumbling violent colicky pain & sudden urging, during stool tenesmus & much flatus & after stool extreme weakness, profuse sweating.                        Aloe socotrina
• Diarrhoea, after eating or drinking cold fruit, ice-cream, ice-water, strong cheese etc.; stool scanty, dark-coloured, offensive < 1-2 P.M.; 12-2 A.M . & whether small or large followed by great prostration & cold sweat. Burning thirst for cold water, drinks often but little.   – Arsenic 
• White mucus, like small pieces of popped corn, proceeded by pinching colic < night. Children suffering from worms, grits teeth during sleep & they are very cross, do not want to be touched or crossed or carried; constant digging & boring at the nose. Canine hunger, hungry soon after a full meal, craving for sweets, different things but refuses mother’s milk. Child gets on hands & knees in sleep, on abdomen. Night terrors of children; cries out, screams, wakes frightened.                                                                                            – Cina maritime
• Involuntary stool passed along with painful, scanty, transparent, jelly-like mucus; pain, as if anus were torn open with prolapse. Stool contains large quantities of white shredding particles; painless, involuntary, excoriating with griping colic & tenesmus. After stool the child feels so exhausted that it fall asleep, great thirst & aversion to smell of cocked food.                                  – Colchicum autumnale
• Stool during right after nursing, undigested, small, bilious, frothy, frequent Jelly-like stool, preceded by severe colicky pain, coming on in paroxysm, causing child twist & double up with every stool; pain > by hard pressure & bending double. Dysenteric stool renewed each time by the least food or drink.                                              – Colocynthis
• Yellowish, frequent, slimy, flaked stool with mucus. The child drawing the abdomen while straining with pains radiate from abdomen to back, chest, arms worse bending forward & while lying; better walking about or bending backward. Rumbling with emission of much flatus.                                                                          – Dioscorea villosa 
• Sour smelling, watery diarrhoea, thin, muddy stool < at night. Child is good all day, but screams & restless, troublesome at night. Face cold & blue.                                     – Jalapa
• Painless, copious debilitating diarrhoea, followed by great weakness with thirst for very cold water. Very foetid stools & flatus. Involuntary; seems as if anus remained open – Phosphorus
• Rumbling watery stool < at night, with colic, great chilliness. No two stools alike. Dry mouth without thirst, irresistible desire to fresh air.                                                            – Pulsatilla

1. Some rubrics in Kent repertory regarding diarrhoea after taking some particular food–

• Egg – Chin. Ars.
• Fish – Chin. Ars.
• Fruits – Bry., Puls.,Croton tig.
• Sugar, Candy – Argn., Croton tig., Gamb.
• Rasin, cake – ipecac.
• Choclate after – lithium c, borax.

1. Diarrhoea, after change of diet –

• Diarrhoea after change of diet specially, indigestible food, even when taken by the nurse, causes diarrhoea of child who is very irritable, hypersensitive. Scanty stool with much ineffectual desire, or passing but small quantities at each attempt. Painful stool, stools relieve pains for a time with first half of tongue clean, posteriorly covered with deep fur, white yellow cracked edge.           – Nux vom                                                                                        
• Another medicine is – Allium sativa.

1. Diarrhoea, after change of weather–

• Green, watery, slimy, bloody, mucus, especially in summer, when the weather suddenly becomes cold; from damp, cold weather along with burning  thirst for cold drinks-Dulcamara
• Other medicines are – Bry., Psorium.

1. Summer diarrhoea – 

• It is a valuable remedy for summer diarrhoea. Copious watery stool, with much urging; always forcibly shot out, with gurgling in intestines; worse, drinking the least quantity or even while eating. Constant urging to stool, followed by sudden evacuation of offensive pasty stool. Very little prostration, passage every half hour, from morning till evening, not at night. Colic > from hot milk.      – Croton tig                                                                                                
• Other medicines are – Aethusa, Bismuth, Dulcamara.

1. Diarrhoea from fright –

• From fear painless diarhhoea, not debilitating, white or yellow, watery; from acids, involuntary with flatus in weakly, delicate, rachitic child. Bloated abdomen with voracious appetite & great thirst for cold milk.                                                                    – Acid phos
• Great physical & mental restlessness with acute, sudden violent invasion after fright. Frequent, small stool with tenesmus; green, chopped like herbs. Watery diarrhoea in children with colic, which no position relieves. Child cries & complain much, sleepless & restless. White coated tongue with thirst for cold water.     – Aconite                                                
• Painless or involuntary stool after fright, emotional excitement, bad news etc. Cream coloured stool. Child starts and grasps the nurse, and screams as if afraid of falling.        – Gelsemium
• Involuntary stool especially after fright; painless, black & offensive, watery stool accompanied by heavy, stupid sleep, stertorous breathing, sweaty skin, dark mehogony- brown face of child. Dry tongue, no desire to eat.                                                       – Opium
• Stool slimy, frothy, dark or bloody with much straining < at night and with much colic > lying down; great tenesmus before & after, not > stool followed by chilliness & a “cannot finish” sensation. Profuse sour smelling night sweat, especially on forhead, feels cold; large, flabby tongue, salivation & glandular swelling  – Merc sol                                                               
• After fright frequent, greenish, watery, copious, mixed with flakes, painful, forcibly evacuated followed by a great prostration with thirst for large quantities of very cold water; cutting colic with cramp commensing in hands & feet & spreading all over < at least movement with vomiting. Baby looks prostrated after each stool, cold sweat on forhead, and baby craves for fruit, cold icy thing, salt etc. & averse to warm food.                                   – Veratrum alb

1. Diarrhoea after excitement –

• Watery, foetid, green mucus stool like chopped spinach in flakes < after drinking, after  kicks; cross, irritable, does not want to be touched with dread of downward motion with large flabby tongue, must protrude it to keep it cool. Head & neck sweat profusely during sleep, offensive. Baby looks old, emaciated, dirty, greasy, brownish, wrinkled skin, hangs in fold.       – Sanicula aqua                                                                                                        
• Another medicine is – Chammomila
• Diarrhoea in acute hydrocephalus –
• Watery, involuntary, clear, tenacious, colourless, jelly-like mucus, white stool; like frog spawn during acute hydrocephalus in weakly, delicate children prone to brain trouble with serous affection with general muscular weakness. Stool preceded by colic > after every stool, followed by burning, smarting pain in anus. – Helleborus niger                                           

1. Diarrhoea in marasmus infants –

• Alternate diarrhoea & constipation; lienteria i.e. food passes undigested form. Child is ill-natured, cross, irritable, would like to do something cruel. Marasmus especially of lower extremities, yet with ravenous hunger. Wrinkled, cold, dry, pale, blue rings eyes & skin is flabby, hangs loose in fold, horrible smell from mouth.  –  Abrotanum                                                                                             
• Chronic diarrhoea of marasmatic child, emaciation of neck, greasy appearance of face, profuse gushing, greying, greenish, watery diarrhoea with mapped tongue, violent thirst, longing for salt, ravenous appetite. Child cross, irritable, slow in learning to walk.          – Natrum mur 
• In chronic & obstinate diarrhoea of under- nourished children during metabolic disorder like marasmus & ricket, also during dentition, where indicated remedies cannot stop it; when one of the parents especially mothers if physically ill during pregnancy, like vomiting, convulsion or oedema etc.. Rolling flatulence with gurgling, then offensive, loose gassy stool & there is no particular time of aggravattion. Arrested development of children with craving for large amount of sweets & thirst for cold water. Chilliness & sensitive to cold.        – Thyroidinum
• Other medicines are – Aethusa, Iodum, Silicea, Cal. Phos., Sulphur, Tuberculinum.

CONCLUSION 
After going through this study we come at conclusion that we can effectively cure infantile diarrhoea after individualisation of each case. In the treatment of Diarrhoea in children, the aim is not only to stop the loose stool but also help to improve rapidly the general wellbeing of the child, but acute prescription if failed to cure it, then we have to look the miasm behind it which is mainly Psora. Psoric diarrhoea may be any colour but often induced by over-eating, patient being always hungry & eats beyond capacity of digestion; watery, undigested, offensive, morning diarrhoea with no exhaustion. Diarrhoea due to fright, bad news etc.  It is worse from cold, motion, eating, drinking cold thing & better warm drink. Sometime it is a great weakness after stool, so in such case we must think of some antipsoric medicines for complete cure purpose.

REFERENCES – 

1. Ghai O.P., Gupta Piyush, Paul V K: Ghai Essential Pediatrics; 6^th Revised & Enlarge edition; 2004; CBC publishers & Distributors; New delhi.
2. Allen, H.C:  Keynotes & characteristics with comparisons of some of the eading remedies of the materia medica: Reprint edition; 2003; B. Jain publishers Pvt Ltd; New Delhi.
3. Boricke. W; Pocket Manual of Homoeopathic Materia Medica with Repertory; Reprint edition: 2000; B. Jain publishers Pvt Ltd, New Delhi.
4. Kent JT. Repertory of Homoeopathic Materia Medica, Indian edition, New Delhi:   

DR. SUPRIYA HALDER, B.H.M.S (WBUHS)
Post Graduate Trainee
Department of Homoeopathic Materia Medica

Under guidance of
Dr. Arpita Basu, B.H.M.S, M.D (Hom)  H.O.D ,  
Department Of Homoeopathic Materia Medica
Mahesh Bhattacharyya Homoeopathic Medical College and Hospital Dumurjala, Howrah- 711101