Homoeopathic Management in Tof Grierson-Gopalan Syndrome – A Case Report

Dr. Jayashree.P

Abstract
Grierson Gopalan syndrome, also known as burning feet syndrome is a frequently encountered condition present as an isolated symptom or secondary to various causes. A case of 48-year old male complaining of isolated burning of feet was successfully treated with individualized homoeopathic medicine Argentum nitricum.

Keywords : Grierson-Gopalan Syndrome, burning foot syndrome, Argentum nitricum, homoeopathy

Introduction
Grierson Gopalan Syndrome or “burning feet syndrome” was first described by Grierson in 1829 and Gopalan in 1946, both in India. Burning feet syndrome is characterized by a sensation of burning and heaviness in the feet and lower extremities. It is a condition predominantly seen in the Asian and Far East countries. Frequently encountered in the summers in patients over but not specific to the age of 50. ^[1]

Etiology

There is no specific aetiology for Burning feet syndrome. It can occur as an isolated symptom or as part of a symptom complex in association with other clinical conditions.^[2]

Few clinical conditions that are associated with burning foot syndrome are:

1. Nutritional : Associated with Vitamin B deficiency
2. Endocrine : Associated with Type 1 and 2 Diabetes and Hypothyroidism
3. Hereditary : It has an Autosomal Dominant inheritance
4. Mechanical : Mechanical compression of peripheral nerves as in tarsal tunnel syndrome, nerve entrapments in sciatic neuropathy and spinal arteriovenous malformation.
5. Idiopathic : No abnormalities seen even after extensive investigations.

Clinical Feature
The main symptom experienced by patients is burning, heaviness, numbness or dull pain in the feet. Complaints can extend to ankles, dorsum of feet or even lower limbs in extreme cases but in majority of cases it is restricted to the feet.^[3] In cases where the cause of burning feet is due to a vitamin deficiency, other symptoms of the vitamin deficient generally precedes the burning feet. No other local signs like tenderness ,skin changes or muscle atrophy are present associated with burning feet. Symptoms are usually aggravated in the night.

Diagnosis
Clinical history and thorough laboratory investigations are done to differentiate between idiopathic cause or if it is secondary to other underlying disease to plan the treatment.

Case

Presenting Complaint

A 48-year-old male patient had visited Government Homoeopathic Medical college and Hospital, Bengaluru on 07/08/2023 complaining of burning of feet since 3 years. Patient also complained of low back pain since 7 months. Patient is a known case of Irritable Bowel syndrome since his childhood.

History of Presenting Complaint

1. Patient had developed burning of bilateral feet since 3 years. Underwent various laboratory investigations and the reports came out to be normal.
   Diabetic profile, vitamin profile, thyroid profile, Complete blood count was normal
   MRI lumbar spine – Normal

Location	Sensation	Modality	Concomittent
B/L feet	Burning	< night	none

2. Patient developed low back pain 6 months ago which was gradual in onset. Was taking allopathic medications for pain relief which was temporary relief to the patient.

Location	Sensation	Modality	Concomittent
Low back	Shooting type of pain	< night, cold	none

No history of fall or trauma to the back

Past History

• No H/O surgery and accidents
• Irritable Bowel syndrome since childhood:

Patient was having few episodes of diarrhoea followed by constipation for few weeks in a year since childhood which was later diagnosed to be as IBS

Precipitating factor – Stress, fear

Family History

• Father – Alive – K/C/O Hypertension
• Mother – Dead – old age
• Siblings – 1 elder brother- Apparently healthy

1 younger sister – K/c/o PCOD

Personal History 

• Diet – mixed
• Appetite – Good
• Hunger – Good
• Desire – Sweets
• Aversion – nothing specific
• Thirst – 2.5 L/day, thirsty
• Urine – Normal
• Stools – regular occasional burning during normal days
• Perspiration – upon exertion on the back
• Sleep – Disturbed, wakes up in the middle and cannot go back to sleep again
• Dreams – snakes, ghost
• Habit – Nothing specific
• Thermals – Hot

Life space investigation
Patient was born and brought up in a village in Jharkhand. Studied till B.com. Was interested in Painting since childhood. Started painting as a hobby and later started selling his paintings since college. Patient started working as in a private accounting firm. Married at the age of 25 in an arranged marriage set up. Patient and his wife were staying with his parents and his brother’s family. Patient wanted to quit the accounting firm and take up a career in painting as he was given a bigger opportunity in Bangalore. His family was against it resulting in a quarrel between father and him. Out of anger, he shifted with his family to Bangalore and started working as a painting artist. Patient felt sad that his father wasn’t able to understand him and feels alone even now despite having his wife around him. He has 2 sons. His painting business started failing. This upset him so much that he was unable to paint pictures like he used to do before. Every day he feels sad and angry that his dream business is failing and he is unable to move forward in his dream. Patient says he no more feels motivated to paint. Failing business resulted in financial difficulties. Patient says he has debts and is now worried about clearing them too.

On observation, the patient had a hurried walking.

General Physical Examination

Patient is conscious and oriented to day, date, time and place

• Built and nourishment – Moderate
• Weight = 78 kgs Height = 5.7ft
• Pallor – absent
• Icterus – absent
• Cyanosis – absent
• Edema – absent
• Clubbing – absent
• Head = Hair –healthy, scalp – healthy
• Eyes – conjunctiva – pink, Sclera – clear
• Ears –no discharge
• Nose – no DNS & Polyp
• Mouth = tongue – clean, teeth – hygienic, gums – pink, buccal mucosa – pink
• Neck – no lymphadenopathy
• Extremities = no deformities
• Skin = healthy
• Nails = no clubbing

Vitals

• BP – 130/90 mm of Hg
• RR – 18 cycle/min
• PR- 75 bpm
• Temp – Afebrile

Systemic Examination

• Respiratory system =  B/l NVBS+
• Gastrointestinal system = Soft, non-tender, Bowel sounds – 2/min
• Cardiovascular system = S_{1 ,} S₂ +
• Central nervous system = Conscious & oriented to date, time & place.

Nosological Diagnosis

Burning feet syndrome

Analysis of the Case

	COMMON		UNCOMMON
	Burning of bilateral feet Low back pain		•        <night, •        Shooting type of pain •        Thermally – Hot •        Sleep – Disturbed, wakes up in the middle and cannot go back to sleep again •        Dreams – snakes, ghost •        Desire – Sweets

Evaluation of symptoms

Mental generals	Physical generals		Particulars
• Loss of ambition • Forsaken feeling	•        Thermally hot •        Sleep – Disturbed, wakes up in the middle and cannot go back to sleep again •        Dreams – snakes, ghost •        Desire – Sweets	•	Burning of b/l feet <night Low back pain < night Shooting type of pain

 Totality of Symptoms

• Loss of ambition
• Forsaken feeling
• Desire – sweets
• Dreams – snakes
• Shooting type of pain in the back
• Burning of bilateral feet

Repertorial Totality

• Mind – Ambition – loss of
• Mind – Delusion – forsaken, is
• Back – Pain – shooting pain [cross reference – Back – pain – stitching pain]
• Dreams- snakes
• Generals – Food and Drinks – Sweets – desire
• Generals – pain- internally-burning

Repertory

Synthesis ^[4]

Repertorial Result

• Arg-n – 6/12
• Sepia – 5/10
• Kali carb – 5/8
• Nat-c – 5/8

Prescription

R_{x  :} Argentum nitricum 200 – 1 dose

Basis of prescription
Based on the analysis of mental generals, physical generals, particulars and repertorial result, Argentum nitricum was prescribed.  Thermally the patient is towards hot, had a history of irritable bowel syndrome, had a hurried walk and patient was inclined towards being creative which is a feature of Row 5 in the periodic table to which Argentum belongs. ^[5][6][7]

Follow up

7/9/2023 :

•  Low back pain better by 60%
• Burning of feet persists
• Sleep – Sound sleep, refreshing
• No episodes of dreams of snake or ghost
• Other generals good
• No fresh complaints

R_x Pl/BD/30 day

3/10/2023

• Low back pain – nil
• Burning of feet occasionally present
• Generals –Good

5/11/2023

• Low back pain – nil
• Burning of feet – nil
• Generals – Good

Conclusion
Grierson Gopalan syndrome is a bothersome condition to the patients which has limited treatment options in cases of idiopathic causes. Homoeopathy has tremendous scope in such cases. Like the above case report, the patient was recovered by constitutional homoeopathic treatment within a span of 3 months. This proves that the scope of homoeopathy in such cases can be further studied.

Declaration of patient consent
 The authors certify that they have obtained appropriate patient consent form. The patient understands that his name and initials will not be published.

Financial support and sponsorship

Nil

Conflicts of interest

None declared

References

1. Makkar RP, Arora A, Monga A, Gupta AK, Mukhopadhyay S. Burning feet syndrome. A clinical review. Aust Fam Physician. 2003 Dec;32(12):1006-9.
2. Mukhopadhyay S, Arora A, Monga A, Makkar RP, Gupta AK. Burning feet syndrome: a clinical review.
3. Gopalan C. The’burning-feet’syndrome. The Indian Medical Gazette. 1946 Jan;81(1):22.
4. Frederik Schroyens. Synthesis. London: Homeopathic Book Publishers; 1993.
5. Sankaran R. Structure. 2008.
6. Sankaran R. The soul of remedies. in the soul of remedies 1997. Homoeopathic medical publishers.
7. Vermeulen F.Prisma, the arcana of materia medica illuminated. Haarlem,Netherlands: Emryss Publishers,2004

Dr. Jayashree.P
PG Scholar, Department of Practice of Medicine
Government Homoeopathic Medical College & Hospital, Bengaluru-560079
drjayashreepathuri@gmail.com

Under the Guidance of :
Dr. Praveen Kumar PD MD(Hom)
HOD, Department of Practice of Medicine
Government Homoeopathic Medical College & Hospital, Bengaluru-560079