Homoeopathic management of different types of fever

Dr Sreelekshmi S

ABSTRACT:
Fever is an elevation of body’s temperature above the normal circadian variation because of the changes in the thermoregulatory centre, located in the hypothalamus.

KEYWORDS: Fever, Temperature, Homoeopathic medicines.

INTRODUCTION:
Fever is the most common presenting symptom to a physician. Also commonly, Pyrexia, Greek pyr meaning fire and febrile, in Latin febris meaning fever. May be associated with other symptoms like chills, rigors, body ache, generalised weakness, headache, anorexia etc. Normally heat is produced in the body and being lost to surroundings. Rate of heat production is equal to rate of heat loss and the person is said to be in heat balance. When there is any disturbance to this equilibrium between the two, then body temperature may rise and cause fever or fall and cause Hypothermia. Core body temperature is normally maintained within a range of 36.0°C – 37.5°C (97°F – 99.5°F).

MAXIMUM NORMAL ORAL TEMPERATURE:

• At 6AM 37.0°C (98.6°F)
• At 6PM 37.6°C (99.6°F)
• The normal diurnal variation is 1°F.

Can be measured in:

• Mouth (Oral) 1F > Axillary temp
• Axilla (Axillary)
• Rectum (Rectal): 1F > oral temp
• Over the Skin (Surface temperature)
• Rectal > Oral > Axilla

Variation:

BODY TEMPERATURE	FARHENNHEIT (ORALLY)
Normal	98.6 – 99.9
Febrile	>100
Mild/Low Grade Fever	100.5 – 102.2
Moderate Grade Fever	102.2 – 104
High Grade Fever	104.1 – 106
Hyperpyrexia	>106
Hypothermia	<95F / 35C.

Various Relationships:

• With every 1F rise of core body temperature, above 100F,
• Pulse rate increases by 10
• Respiratory rate by 4
• BMR by 7
• Oxygen consumption increases by 13% (Fever increases O2 demand).

Factors Determining Rate of Heat Production

• Basal metabolic rate of body
• Muscle activity
• Effect of thyroid hormones
• Effect of epinephrine and norepinephrine.

Method of Heat Loss from Body

• Radiation: Loss of heat from body in form of infrared rays.
• Conduction: Heat is conducted from body to objects in contact with it,
• g. chair, bed, etc.
• Convection: Heat is lost from body by air currents surrounding it.
• Evaporation: Evaporation of water (sweat) from body surface serves as an important protective mechanism in reducing body temperature.

FEVER WITH RELATIVE BRADYCARDIA:
This law when not followed in respect of pulse, called relative bradycardia ( faget sign) reported in Typhoid fever, typhus, leptospirosis, malaria, Meningitis, viral fever(influenza),brucellosis, drug induced fever.

FEVER WITH RASHES:

• Rash appearing in 1^st day of fever: Chickenpox
• Rash appearing in 4^th day of fever: Measles
• Rash appearing on 7^th day of fever: Typhoid (rose spots)

 

STAGES OF FEVER

1. Prodrome – nonspecific complaints, mild headache, fatigue, general malaise, aches, and pains.
2. Temperature rises – generalized shaking with chills and feeling of being cold, vasoconstriction, piloerection precede onset of shivering, skin is pale
3. Flush – cutaneous vasodilation occurs and skin becomes warm, flushed.
4. Defervescence – Initiation of sweating.

  PATHOGENESIS OF FEVER

• Pyrogen – Any substance that cause fever
• Exogenous pyrogens – derived from outside the patient, microbial products, microbial toxins, or whole microorganisms.
• Bacteria: Lipopolysaccharide components, peptidoglycans and muramyl peptide derivatives, Toxins
• Virus: Double stranded RNA
• Fungi: Mannan and glucan components

These induce host cells, i.e, blood leukocytes, tissue macrophages to produce      endogenous pyrogens (e.g. interleukin-1). Leads to synthesis of proinflammatory mediators – Endogenous pyrogens, include IL-1, IL-4, IL-6, TNF, ciliary neurotropic factor (CNTF), IFN-alpha. Endogenous pyrogens increase set point hypothalamic thermoregulatory centre through prostaglandin E2. Leads to Heat conservation and Production producing Fever.

PATTERNS OF FEVER:

Continuous Fever: The temperature remains elevated above normal range without touching the baseline and the fluctuation doesn’t exceed above 1F. (diurnal variation). E.g. early stages of pneumonia.

Remittent Fever: The temperature fluctuation exceeds 1F, without touching the baseline. E.g. enteric fever

Intermittent Fever: The elevated temperature touches the baseline in between. The temperature rises and falls, touching normal in between the peaks. E.g. Malaria

Relapsing Fever: Febrile episodes are separated by normal temperature for more than 1 day.

Tertian fever: occurs on 1^st and 3^rd day (alternately). E.g. Plasm. Vivax, Plasm. falciparum.

Quartan fever: occurs on 1^st and 4^th day. E.g. Plasm. malariae

Pal-Ebstein fever: fever lasting for 3 – 10 days followed by an afebrile period of 3 – 10 days.            E.g. Hodgkins and other lymphomas.

Hyperpyrexia:

• Hyperpyrexia denotes high temperature, equal to more than 106F/41C.
• It results from the setting of the hypothalamic thermostat to a higher level or loss of control of the thermoregulatory mechanism.
• It may be observed in severe infections, intracranial haemorrhage etc.
• If there is uncontrolled production of body heat exceeding the ability of the body to dissipate it, hyperthermia results.
• It’s a medical emergency with high mortality and morbidity.

Causes of Fever:

• Infection: Commonest cause of fever in all countries, especially developing countries like India is infection. This could be bacterial, viral, rickettsial, chlamydial, protozoal, fungal and Almost all infections cause fever as a general reaction.
• Inflammatory causes not attributable to infections: Connective tissue diseases, e.g. systemic lupus erythematosus, rheumatoid disease.
• Hypersensitivity reactions: Reaction to drugs, antisera, biological products-serum sickness.
• Trauma: Accidents, blunt trauma and major surgery are accompanied by fever, even in the absence of infective complications.
• Extravasation of blood into tissue spaces: Gives rise to fever.
• Neurological disorders: Lesions in the brain-stem may give rise to high fever, e.g. pontine hemorrhage.
• Endocrine causes: Hyperthyroidism, thyroid storm, ovulation.
• Physical agents: Heat hyperpyrexia, post-irradiation fever, dehydration fever in infants and children.
• Neoplasms: Several neoplasms such as hypernephroma and primary carcinoma of the liver give rise to fever as an early manifestation. In acute leukemias and lymphomas fever is a common symptom.
• Severe muscular effort: Convulsions, especially status epilepticus, tetanus spasms and severe exercise in closed environments may give rise to fever.
• Factitious fever: Factitious means produced artificially and not by a genuine process. Many malingerers pretend illness by manipulating the thermometer so as to record higher temperatures. This is called factitious fever.
• Very rarely some individuals may have their normal temperature upto 0.5°C above 37°C, with exaggerated circadian rhythm.
• Psychogenic fever: Patients and relatives come with complaint of fever, due to wrong interpretation of the normal body temperature – due to stress.

Primary investigations for a case of Fever:

Complete Blood Count (CBC)

• Purpose: To check for signs of infection (e.g., elevated white blood cell count), anemia, and other blood disorders.
• Interpretation: Elevated white blood cells can indicate bacterial infections, while specific patterns (e.g., increased lymphocytes) might suggest viral infections.

Blood Cultures

• Purpose: To identify the presence of bacteria or fungi in the bloodstream.
• Interpretation: Positive cultures can indicate septicemia and help guide antibiotic therapy.

Urineanalysis

• Purpose: To detect urinary tract infections (UTIs) and other renal issues.
• Interpretation: Presence of leukocytes, nitrites, or bacteria in urine suggests a UTI.

Chest X-ray

• Purpose: To identify respiratory infections, such as pneumonia or tuberculosis.
• Interpretation: Infiltrates or consolidations on the X-ray can indicate bacterial or viral pneumonia.

Basic Metabolic Panel (BMP)

• Purpose: To evaluate renal function, electrolyte balance, and glucose levels.
• Interpretation: Abnormal results can indicate dehydration, kidney dysfunction, or other metabolic imbalances.

Liver Function Tests (LFTs)

• Purpose: To assess liver function and detect hepatic causes of fever.
• Interpretation: Elevated liver enzymes can suggest hepatitis or other liver diseases.

Serological Tests

• Purpose: To identify specific infections (e.g., HIV, hepatitis, mononucleosis).
• Interpretation: Positive results indicate past or present infections.

Rapid Diagnostic Tests

• Purpose: To quickly diagnose common infections such as influenza, malaria, or streptococcal pharyngitis.
• Interpretation: Positive results confirm the presence of the specific pathogen.

C-reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR)

• Purpose: To assess the level of inflammation in the body.
• Interpretation: Elevated CRP and ESR levels suggest an inflammatory or infectious process.

Specific Cultures and Sensitivities

• Purpose: Depending on clinical suspicion, cultures from sputum, throat swabs, wound swabs, or cerebrospinal fluid (CSF) may be collected.
• Interpretation: Positive cultures guide targeted antibiotic therapy.

Malaria Smear

• Purpose: To diagnose malaria in patients with relevant travel history or clinical suspicion.
• Interpretation: Identification of malaria parasites in blood smears confirms diagnosis.

Homoeopathic Medicines and it’s Comparison:

1. Aconitum napellus:

Sthenic Fevers, with chilliness on the slightest movement; dry heat of skin, thirst, red cheeks, quickened respiration; full, bounding, rapid, tense pulse, with mental anxiety and aggravation towards evening. Every motion makes the patient chilly, but he is at the same time very restless from the mental anxiety. Aconite ceases to be of use in the second stage of inflammation, when it has localised itself. Characteristic – Aconite is most frequently indicated in recent cases occurring in young persons, especially girls of a full plethoric habit, who led a sedentary life; persons easily affected by atmospheric changes; dark hair and eyes, rigid muscles. Complaints from exposure to dry, cold air; dry north or west winds (land winds) ; drafts of air while in a perspiration; bad effects of checked perspiration. On rising from a recumbent posture, the red face becomes deathly pale, or he becomes faint or giddy and falls over; he fears to rise again; often accompanied by vanishing of sight and unconsciousness. GREAT FEAR AND ANXIETY OF MIND, with great nervous excitability; afraid to go out, to go into a crowd where there is any excitement or many people, to cross a street.

His countenance is expressive of fear; his life is rendered miserable by it; is sure his disease will prove fatal; predicts the day he will die; fear of death during pregnancy. Hahnemann says: “Whenever Aconite is chosen homoeopathically, you must, above all, observe the moral symptoms, and be careful that it closely resembles them; the anguish of mind and body; the restlessness; the disquiet not to be allayed.”

• Aggravation -In the evening and night the pains are in-supportable; in a warm room; when rising in bed; lying on affected side (Hep., Nux m.).
• Amelioration, During the day, in the open air (Alum., Mag. c., Puls., Sab.) ; while at rest (except at night in bed) ; after perspiration, from wine.
• Relation -Aconite is the acute of Sulphur, and both precedes and follows it in acute inflammatory ronditions.
• Abuse of Aconite requires Sulphur.
• Type – Quotidian; quartan. No regularity; periodicity not marked. Apt to become synochal, or inflammatory symptoms with congestion of local organs, as head and chest, may form a complication.
• Time -Usually in the evening.
• Cause —Dry, cold north or west winds; hot days and cool nights; getting wet (Dulc., Rhus) ; suppressed perspiration by uncovering or sitting in a draft; by fright; rheumatic exposure.

2. Belladonna: When there are symptoms of delirium and cerebral excitement present     and a pungent heat of the Skin. Characteristic-Adapted to bilious, lymphatic, plethoric constitutions; persons who are jovial and entertaining when well, but violent and often delirious when sick.

• Women and children, with light hair, blue eyes, fine complexion, delicate skin; sensitive, nervous, threatened with con-vulsions.
• Great liability to take cold, sensitive to draft of air, especially when uncovering the head; from having the hair cut (Hep.) ; tonsils swell after riding in a cold wind (Acon., Hp., Rhus).Over-excitability of all the senses; convulsions during den-tition; spasms of single muscles or the whole body; chorea, epilepsy.Quick sensation and motion; eyes snap and move quickly:Convulsions during teething, with fever (without fever,
• Mag. p.) ; come on suddenly, head hot, feet cold.Rush of blood to head and face (Amyl, Glon., Mel.).Pains come on suddenly, last indefinitely, cease suddenly (Mag. p.).Pains: usually in short attacks; cause redness of face and eyes; with throbbing of carotids and fulness of head.
• Imagines he sees ghosts, hideous faces, and various insects (Stram.) ; black animals, dogs, wolves.Fear of imaginary things, wants to run away from them; hallucinations.
• Violent delirium; disposition to bite, spit, strike and tear things; breaks into fits of laughter and gnashes the teeth; wants to bite and strike the attendants (Stram.); tries to escape (Hell., Hyos.).
• Head hot and painful; face flushed; eyes wild, staring, pupils dilated; pulse full and bounding, globules like buckshot striking the finger; mucous membrane of mouth dry; stool tardy; urine suppressed; sleepy but cannot sleep (Cham., Lach., Op.).
• Relations – Complementary: Calcarea. Belladonna is the acute of Calcarea and Tuberculinum which are often required to complete a cure.Aggravation.-From touch, motion, noise, draught of air, looking at bright shining objects (Lys., Stram.) ; after
• 3 P.M.and midnight; while drinking; uncovering; hot sun; lying down.Amelioration.-Rest; standing or sitting erect; warm room.
• Type — Quotidian, tertian. Sometimes the type is anticipating. Periodicity not marked. Continued; typhoid; yellow.
• Time —6 p. M. In evening, or at night.

3. Bryonia alba: Characteristic -Suitable to the gouty or rheumatic dia-thesis; persons with bilious tendency, exceedingly irritable, inclined to be angry; black hair, dark complexion and firm muscular fibre; prone to so-called “bilious attacks;” dry, nervous, slender (Nux).

Hering says: “Indicated in light complexions but more in dark. Complaints: when warm weather sets in after cold days; from cold drinks or ices in hot weather; after taking cold or getting heated in summer; from exposure to draft, cold wind (Acon., Hep.); suppressed discharges of menses, milk or eruption of acute exanthema. The pains are stitching, tearing, worse at night, greatly < by motion, > by rest and lying on the painful side (Ptel., Puls.-Similar pain but < and > are opposite, Kali c.). The parts which are the seat of subjective pain become subsequently sensitive to external pressure, and then swollen and red. Children dislike to be carried, or to be raised. Ailments from chagrin, mortification, anger (Col., Staph.) ; violence, with chilliness and coldness; after anger chilly, but with head hot and face red (Aur.). Constant motion of left arm and leg (Apoc., Hell.) • Excessive dryness of mucous membrane of entire body; lips and tongue dry, parched, cracked; stool, dry as if burnt; urine, dark, and scanty; great thirst; cough, dry, hard, racking, with scanty expectoration. In delirium: talks constantly about his business; desires to get out of bed and go home (Act., Hyos.). Headache: when stooping, as if brain would burst through forehead; from ironing; on coughing; in morning after rising, or when first opening the eyes; commencing in morning, gradually increasing till evening; from constipation; dull pain Headache: gastric, rheumatic, congestive; with vertigo, heaviness, pressure, and rush of blood to head. Aggravation.-Motion; exertion; touch; cannot sit up, gets faint or sick or both; warmth, warm food; at night; suppressed discharges. One of the chief characteristics of Bryonia is, < from any motion, and corresponding > from absolute rest, either mental or physical. Amelioration -Lying, especially on painful side (Ptel., Puls.); rest, cold, eating cold things; pressure, heat, sweat. Complementary: Alumina, Rhus tox.

Type -Quotidian, tertian or quartan fevers, periodical sweats on single parts; restless every other night. Anticipating or postponing. Typhoid; typhus; yellow fever.

Time-All periods.-time not characteristic. Morning.

Cause-Fevers caused by getting wet (Cal., Rhus sleeping in damp room or bed, Aran.); in dry weather, whether hot or cold.

Prodrome-Great thirst for large quantities of cold water.Stretching and drawing in the limbs; violent headache, stitch-ing, jerking, throbbing from before backwards as if the head would burst; vertigo.

4. Gelsemium sempervirans: Three D’s, Drowsiness, Dullness, & Dizziness: Soreness of muscles & absence of thirst, great prostration & remission of symptoms. Characteristic-Adapted to children; young people; women of a nervous, hysterical temperament (Croc., Ign.) ; irritable, sensitive, excitable; onanists, both sexes (Kali p.).Desire to be quiet, to be let alone, does not wish to speak, nor have any one near her for company, even if the person be silent (Ign.).Fear of death (Ars.); utter lack of courage.

Weakness and trembling; of tongue, hands, legs; of the entire body.

Complaints: from exciting or bad news (from pleasant sur-prises, Coff.); sudden emotions (Ign.); the anticipation of any unusual ordeal brings on diarrhea; stage fright, nervous dread of appearing in public (Arg. n.); general depression from heat of sun or summer.Vertigo: spreading from the occiput (Sil.) ; with diplopia, dim vision, loss of sight; seems intoxicated when trying to move.

• Children: fear of falling, seize the nurse, grasp the crib (Bor., San.).
• Lack of muscular co-ordination (Kali br.); giddy, con-fused; muscles refuse to obey the will.
• Headache: beginning in cervical spine; pains extend over the head, causing a bursting sensation in forehead and eyeballs (Sang., Sil., begin in same way, but are semi-lateral) ; worse from smoking; preceded by blindness (Iris, Kali bi., Lac d.),
• > by profuse urination. Sensation of a band around the head above the eyes (Carb.) Slow pulse of old age.Great heaviness of the eyelids; cannot keep them open (Caust., Graph., Sep.).
• Fears that unless constantly on the move, the heart will cease beating (would cease beating if she moved, Dig.).
• Aggravation-Damp weather; before a thunder storm; sudden emotions; bad news; rest; smoking tobacco; thinking of his ailments; spoken to of his loss.
• Amelioration— In the cold, open air.
• Type-Quotidian; tertian; same hour of the day with every paroxysm (Aran., Ced., Sabad.). Periodicity extends throughout its entire pathogenesis; all its fevers are of a regular type, but characterized by disorders of innervation. Simple uncomplicated cases. When the remittent takes on the intermittent type (reverse of Bap., Eup., Quin.). Malarial, yel-low, typhoid.
• Time.-Afternoon and evening paroxysm 2, 4, 5 and 9 p. M.
• Fever without chill at 10 A. M. (Bap., Nat.). Daily, at same hour.
• Prodrome.-Sudden mental emotions, the anticipation of any unusual ordeal, fright, grief, bad news, may hasten chill os produce diarrhea. Could tell when chill was about to return, as incontinence of urine would set in. Thirst, but does not drink much; hurts to swallow.

5. Eupatorium perfoliatum: Characteristic – Adapted to diseases of old people; worn-out constitutions, especially from inebriety; cachexia, from prolonged or frequent attacks of bilious or intermittent fevers..

• Bruised feeling, as if broken, all over the body (Ar., Lac can., Pyr.).
• Bone pains; affecting the back, limbs, head, chest, particularly the wrists as if dislocated, the eyeballs; the more general and severe the better adapted. Like Bryonia, they are accompanied by headache, constipation and pain in hepatic region, but here the similitude ends.
• In Bryonia, the perspiration is profuse, easily excited by motion, and the pains compel patient to lie still upon the painful side.
• In Eupatorium the sweat is scanty or wanting, the pains cause restlessness without any relief from motion, and there is entire inability to lie on left side.
• Pains as if broken; come quickly and go away as quickly (Bell., Mag. p., Eup. pur.-reverse of Stan.).
• Vertigo: sensation as if falling to the left (cannot turn the head to the left for fear of falling, Col., Con.).
• Cough: chronic; loose with hectic; chest sore, must support it with hands (Bry., Nat. c.); < at night; following measles or suppressed intermittents.
• Painful soreness of eyeballs; coryza, aching in every bone; great prostration in epidemic influenza (Lac c.).
• Relations -Followed well by Natr. mur., Sepia and Tub.
• Aggravation -Motion; drinking; uncovering.
• Type -Tertian; double tertian; rarely double quartan, and then only when changed from original type by Quinine. All types may be cured by it. Anticipating, remittent, bilious, ma-larial; sporadic La Grippe.
• Time —7 A. M.; 7 to 9 P.M.; 7 to 9 A.M. one day, lighter chill at 12 M. next day; 10 a. M.; 12 to 2 p. M.; 5 p. M. Will cure without reference to time, when totality of symptoms is present.
• Prodrome -Insatiable thirst, but drinking causes nausea and vomiting, and hastens the chill. Sick stomach and thirst night before the paroxysm. Thirst, sometimes for warm drinks (Casc., Ced.), one to three hours before the chill; he knows the chill is coming because “he cannot drink enough” (knows chill is coming because she is thirsty, Caps., Cinch., Nat.); yawning, stretching, pain in back, especially over rightilium, and the bones of extremities as if broken. Colicky pain in the upper abdomen (Coc.) ; painful soreness of the eyeballs.
• Must be covered, before and during chill (covered during entire paroxysm, Nux). Hungry (Cina).
• Some remedies having fever without thirst are : Apis, Phosphorous, Pulsatilla,     China & Gelsemium.

RARE REMEDIES:

1. Angustura: very much fatigued, feels it most in the thighs.

• < from touching the affected parts, 3pm in afternoon.
• Type: Fevers occurring in tropical countries, after travelling through swamps in a hot climate.

2. Canchalagua: Pain and fullness in head and scalp, feels tight as if drawn together by a rubber band. Skin of hand resembles washer womens’s hands.

• Type: for Vernal intermittents.
• Chill is severe especially down the spine.
• Excellent appetite as soon as paroxysm is over.

3. Cedron: Especially adapted to working persons of nervous, excitable temperament of a voluptuous disposition. Sick headache every other day at 11am.

• Type: Quotidian, Tertian
• Time: evening at 6 or 6:30pm
• All 3 stages of fever with Thirst.
• Craves warm drinks.

4. Menyanthes: Adapted to complaints from abuse of Cinchona and Quinine. Fevers in which the cold stage predominates, felt most acutely in abdomen and extremities. Anxiety about the heart as if something evil were going to happen. Headache with pressing pain in vertex from above downwards > during hard pressure with hands. Craving for meat. Very efficient remedy in irregular intermittent fever.
5. Polyporus officinalis: Type:Quotidian,tertian. Sporadic or endemic of spring, summer, winter. Time: 5, 10 and 11am. Great languor and aching in the large joints. Chills with slight thirst, alternate with heat several times a day. Heat with thirst. Sweat profuse after midnight. Best adapted to old, long standing cases that have been saturated with quinine.

REFERENCES:

• Harrison’s textbook of medicine
• Davidsons textbook of medicine
• KVK manual of clinical medicine
• Manual of practical medicine by R. Alagappan
• The Therapeutics of Fevers H C Allen
• Essentials of Homoeopathic Therapeutics W A Dewey

Dr Sreelekshmi S.
MD Scholar, Department of Practice of Medicine
Father Muller Homoeopathic Medical College, Mangalore
Guide: Dr M K Kamath