Homoeopathic Management of Renal calculi

Homoeopathic Management of Renal calculi

Dr Jitendra Kumar Srivastava

Background
Urinary stone disease is one of the most painful urologic disorders. In India maximum number of population depends on ground water resources for domestic use and agricultural use , so same in the case of Kanpur( UP INDIA )and its surrounding places .In absence of sufficient rainfall ,the ground water resources are becoming main source of drinking water .Calcium is its predominant constituent ,extra consumption of calcium in drinking water may accumulate in blood and than in kidneys in the form of kidney stone , calcium combines with oxalates to form calcium oxalates and with phosphates it forms calcium phosphates and calcium oxalate phosphate stones.

Another aspect of my work is the water pollution which is caused by tenries in Kanpur and its surrounding district Unnao and Kannauj , these tenries and factories of cosmetic items drains their waste water into the river Ganga.Ganga water is also the chief source of drinking water which is also responsible for the formation of renal stone in larger part of the society .

Other most important part is the manufacturing of masala(TOBACCO SUPPLIMENT IN INDIA) , which is  being eaten by the larger part of the society not only in kanpur but also in adjascent districts .katha and supari are the chief constituent of masala , which is responsible for the production of renal stones not only once but recurrent untill they give up to chew the masala(TOBACCO SUPLIMENT).

Aims And Objective Of Work :–

1. To find out the scientific way of Homoeopathic management for the patient of urinary tract calculi with the involvement of miasmatic stigmas in the causation of disease .
2. To evaluate the correct similimum with the help of Hahnemannian teachings  .
3. To investigate and diagnose the proper malady with the help of different procedures.
4. To suggest the proper preventive measures given by our master and other stalwarts for the management of the psoro-syco or psoro-syphilitic treatment of the disease.

INTRODUCTION:
Urolithiasis is  still a mysterious disease even after extensive research in the field of urology, 85% of calcium stones are idiopathic .It is known since the dawn of history .Even various sophisticated investigations, like radiology, pathology and  others, have failed to pinpoint the exact cause and mechanism .However, factors attributable to urolithiasis have been extensively studied in recent times.

REVIEW OF LITERATURE : Synonyms of the disease are – Urolithiasis or Nephrolithiasis or Renal calculi or Urinary stones. Nephrolithiasis is revived from the Greek “nephros” (kidney) “lithos” (stone) = kidney stone , and urolithiasis from the French “uros” (urine) which in turns comes from Latin urine and Greek ouron meaning urine =urine stone .

The stones themselves are also known as renal calculi ,the word calculus is the Latin word for pebbles.

DEFINITION
Urolithiasis is defined as the formation of stone in urinary organs and tract. It is most frequently occurs in male than in female and in whites than in blacks. It shows a familial disposition .

Urinary calculus is a stone like body composed of urinary salts bound together by a colloid matrix of organic materials . It consists of a nucleus around which concentric layers of urinary salts are deposits.

AGE/SEX : Stones or calculi can be formed at any age but more commonly within the age group of 20-30 yrs , with Male –Female ratio 2:1.

INCIDENCE :People of North America are most commonly affected & higher rate of incidence is found in high temperate zones.

COMMON PRESENTATION :–

CLINICAL FEATURES

SYMPTOMS— It is mainly divided into four groups

1.QUIESCENT CALCULUS—A few stones particularly the phosphates stones may lie dormant for quiet a long period . During this time the stones gradually increase in size with distruction of renal parenchyma . Such stones may be discovered accidentally in X-ray performed for some other reason or is first revealed with renal failure and uraemia.Sometimes such stones are also discovered due to symptoms of urinary infection.

2.PAIN—Pain is the leading symptom of renal calculus in majority of cases .Three types of pain are usually noticed

• Fixed renal pain—This pain is situated in renal angle and anteriorly in the corresponding hypochondrium.This pain is worse in walking motion and jolting.
• Ureteric colic—This is a charecterisitics pain of stone starting from loin extending to groin.
• Reffered pain—This is rarely found and the pain is reffered to whole abdomen or to opposite kidney.

3.HYDRONEPHROSIS— Sometimes patient complaint of  lump and ache in abdomen which is mainly due to hydronephrosis.

4.HAEMATURIA—Occasionally it is the leading symptom.

PHYSICAL SIGNS—

• Tenderness—This mostly present in renal angle posteriorly.This angle is present between 12^th rib and erector spinae muscles.
• Muscle rigidity—It may be found in some cases in the kidney region.
• Swelling – It is present when there is hydronephrosis or pyonephrosis .

COMMON COMPLICATIONS AND EMERGENCIES :–

1.EFFECTS ON SAME KIDNEY.—

• Obstruction
• Infection
• Initiate malignancy

2.EFFECTS ON OPPOSITE KIDNEY.—

• Compensatory hypertrophy
• Stone formation
• Infection
• Calculus anuria

RECURRENCE  :–  For recurrence of  stone only Homoeopathy has got the answer.

ETIOLOGY AND PATHOPHYSIOLOGY

The exact cause of urolithiasis is not known yet today. But the most common factors associated with the formation of stone are as follows :–

1. HYPEREXCREATION OF RELATIVELY INSOLUBLE URINARY CONSTITUENTS—

Oxalate — though oxalate is the major component of 70% of all renal stones, yet hyperoxaluria as a cause of formation of such stone is relatively rare. Cabbage ,rhubarb ,spinach , tomato ,black tea etc. contain large amount of oxalate .Ingestion of excessive amounts of ascorbic acid and orange juice also increase urinary oxalate excreation.But dietary oxalate is usually poorly absorbed and does not play major role in formation of oxalate stones . In fact restriction of these foods has limited effect in prevention of oxalate stones.

Calcium—on regular diets normal urinary excretion of calcium ranges between 200-300 mg. per day .The major calcium in foods are in milk and cheese. Milk and dietary protein also cause increased absorption of calcium from the gut. In these cases calcium excretion may increase up to 450 mg.or more per day.

Uric acid—Many patients with gout form uric acid calculi particularly when under treatment. If the urine is made alkaline and diluted while treating this disease chance of uric acid stone formation is less administration of allopurinol also decreases stone formation.

Cystine—Cystinuria is an hereditary disease which is more common in infants and children. Only a small percentage of patients with cystinuria form stone.

Struvits – Magnesium ammonium phosphates 10-20 % of urinary stones becoming enlarged and branched they are known as staghorn stones. Caused by bacteria proteus klibsella and pseudomonas .

Drug induced stone—In rare cases the long term use of magnesium trisilicate in the treatment of peptic ulcer has produced radio-opaque silicon stone.

Xanthenes stone—very rare resulting from genetic disorder of xanthenes oxidase enzyme deficiency which results in the production of xanthenes and hydroxanthine as an end product of purine metabolism.

12 % of population is affected by acute ureteric obstruction due to passage of a urinary stone .

2.PHYSICAL CHANGES IN THE URINE—

• Urinary pH—The mean urinary pH is 5.85. It is influenced by diet and medicines .If the urine becomes infected with urea splitting bacteria e.g. proteus bacteria . It makes the urine strongly alkaline by liberating ammonia .The inorganic salts which are less soluble in alkaline medium e.g. calcium phosphate and triple phosphate will form urinary stone .
• Colloid content—As mentioned above it has long been claimed that the colloids in the urine allow the crystalloid to be held in a supersaturated state . But the importance of this theory has been questioned recently.
• Decreased concentration of crystalloids – This may be due to low fluid intake excessive water losses in febrile diseases and in hot climates due to excessive perspiration or due to excessive water loss from vomiting and diarrhea.
• Urinary magnesium /calcium ration – This probably has notable influence on stone formation.

3.altered urinary crystalloids and colloids.

4.decreased urinary output of citrate.

5.vitamin-a deficiency .

6.urinary infection.

7.urinary stasis.

8.hyperparathyroidism

Classification of stones

Basically the stones can be divided into two main groups—

Primary stones

Secondary stones

1. Primary stones à

• Oxalate stones
• Cystine stones
• Xanthine stone
• Indigo stones

2. Secondary stones à

• Phosphate stone(calcium and magnesium)
• Mixed stone 

 Treatment and management of  urolithiasis

The treatment of urolithiasis can be understood under following headings

• Medical
• Surgical
• Homoeopathic

MANAGEMENT OF UROLITHIASIS

As our great master has already said in aphorisms of organon that—-

APHORISM 94 

While inquiring into the state of chronic diseases, the particular circumstances of the patient with regard to his ordinary occupations, his usual mode of living and diet, his domestic situation, and so forth, must be well considered and scrutinized, to ascertain what there is in them that may tend to produce or to maintain disease, in order that by their removal the recovery may be promoted.

In many cases, making a few lifestyle changes can prevent kidney stones. An overall diet low in salt and very low in animal protein can greatly reduce chances of developing kidney stones.

APHORISM 125

During all the time the experiment lasts the diet must be strictly regulated; it should be as much as possible destitute of spices, of a purely nutritious and simple character, green vegetables,1 roots and all salads and herb soups (which, even when most carefully prepared, possess some disturbing medicinal qualities) should be avoided. The drinks are to be those usually partaken of, as little stimulating as possible.

As a general rule, restricting intake of calcium doesn`t seem to lower the risk. In fact, researchers have found that women with the highest calcium intake are less likely to develop kidney stones than women who consume less calcium. The reason is that calcium binds with oxalates in the gastrointestinal tract so the oxalates can`t be absorbed from the intestine and excreted by the kidney to form stones.

An exception to this rule occurs when an individual absorbs too much dietary calcium from the intestine. In such a circumstance restricting calcium intake is useful.

Liberal fluid intake – Ingestion of large amount of fluid in the form of beverages such as tender coconut ( coconut water ) ,barley water , fruit juices and other soft drinks will help the patient to excrete over 2 liters of urine per day . Dilute urine prevents concentration of solids and the precipitation of crystals of urate and oxalates.

DIETARY ADVICE—

Our great master  Dr. HAHNEMANN has clearly tells the importance of diet and regimen  in the  ORGANON OF MEDICINE  from  APHORISM 259-263. 

S.NO	FOOD ARTICLE	ACTION
1	Coconut water	Contains substances which inhibits the initial mineral phase formation and also stimulates demineralization.
2	Cornsilk tea	Rich in tartrates ,good inhibitor of stone formation .It also acts as a diuretic.
3	Barley	Exerts diuretic action ,rich in stone inhibitor
4	Pineapple	Reduces fibrin thus preventing stone formation
5	Bananas	Rich in vit-B and potassium which breakdown acid in the body thereby preventing stone formation.
6	Almonds	Rich source of magnesium which is stone inhibitor
7	Lemons	Rich in citrates thus preventing calcium oxalates stone formation
8	Carrots	Rich in pyrophosphates which are stone inhibitor
9	Horse grams	Contains inhibitors
10	Bitter gourd	Contains inhibitors like magnesium ,phosphorous.

APHORISM 259

Considering the minuteness of the doses necessary and proper in homoeopathic treatment, we can easily understand that during the treatment everything must be removed from the diet and regimen which can have any medicinal action, in order that the small dose may not be overwhelmed and extinguished or disturbed by any foreign medicinal irritant.

APHORISM 260

Hence the careful investigation into such obstacles to cure is so much the more necessary in the case of patients affected by chronic diseases, as their diseases are usually aggravated by such noxious influences and other disease – causing errors in the diet and regimen, which often pass unnoticed.

APHORISM 261

The most appropriate regimen during the employment of medicine in chronic disease consists in the removal of such obstacles to recovery, and in supplying where necessary the reverse: innocent moral and intellectual recreation, active exercise in the open air in almost all kinds of weather (daily walks, slight manual labour), suitable, nutritious, unmedicinal food and drink, &c.

APHORISM 262

In acute diseases, on the other hand – except in cases of mental alienation – the subtle, unerring nternal sense of the awakened life – preserving faculty determines so clearly and precisely, that the physician only requires to counsel the friends and attendants to put no obstacles in the way of this voice of nature by refusing anything the patient urgently desires in the way of food, or by trying to persuade him to partake of anything injurious.

APHORISM 263

The desire of the patient affected by an acute disease with regard to food and drink is certainly chiefly for things that give relief; they are, however, not strictly speaking of a medicinal character, and merely supply a sort of want. The slight hindrances that the gratification of this desire, within moderate bounds, could oppose to the radical removal of the disease 141 will be amply counteracted and overcome by the power of the homoeopathically suited medicine and the vital force set free by it, as also by the refreshment that follows from taking what has been so ardently longed for. In like manner, in acute diseases the temperature of the room and the heat or coolness of the bed – coverings must also be arranged entirely in conformity with the patient’s wish. He must be kept free from all over – exertion of mind and exciting emotions.

DIETARY RESTRICTION FOR NEPHROLITHIASIS

Calcium	Leafy vegetable,beans ,cauliflower,egg yolk,milk and milk products ,potatoes,molasses,seesam seed and ragi etc.
Phosphates	Whole cereals,legumes,nuts,and oil seeds,meat,fish ,eggs and milk.
Oxalates	Leafy vegetables ,beetroot,strawberries,tomato,tea,rhubarb,groundnuts,cocoa,chocolates,cashew nuts,beef.
Uric acid	Fish ,meat sweetbread,channa,rajma,moong,chikoo,custard apple.

MEDICAL TREATMENT

Medical treatment depends on the type of the stone produced.

Drugs –

• Alkalinizing agents
• Diuretics
• Chelating agents
• Xanthine oxidase inhibitors
• Antibiotics
• Analgesics

• SUPPLIMENT ADVISED—
• Taking 50 mg a day of vit-B6 with 200-400 mg a day of magnesium (in the form of magnesium citrate) can inhibit stone formation.

SURGICAL TREATMENT

·         Uteroscopic stone extraction

• Percutaneous nephrolithotomy
• Open stone surgery
• ESWL

HOMOEOPATHIC TREATMENT

HOMOEOPATHIC APPROACH OF DISEASE EVOLUTION WITH MIASMATIC BACKGROUND

According To Dr Stuart Close

Homœopathy is both an art and a science. The successful Homœopathician must be both an artist and a scientist. His work must be both artistic and scientific. Theory and practice must go hand in hand. Technique must be governed by definite principles. Performance must be consistent with profession.

According To Fincke

 Homœopathy, as a science, rests fundamentally upon four general principles: Similarity, Contrariety, Proportionality and Infinitesimality, reducible to the universal principle of Homœosis, or Universal Assimilation. (Fincke.)

We know that the first step towards achieving  proper miasmatic interpretation of a case is to record every detail faithfully with all symptoms complete as to location, sensation, modalities, possible causation and concomitants, as well as past history, family history, personal history including mental and physical generals, and a history of various treatments pursued. All this must then be interpreted in terms of the evolution of the symptoms with respect to time.

APHORISM 83

This individualizing examination of a case of disease, for which I shall only give in this place general directions, of which the practitioner will bear in mind only what is applicable for each individual case, demand of the physician nothing but freedom from prejudice and sound senses, attention in observing and fidelity in tracing the picture of the disease.

An interesting parallel observation here is that the artificial drug disease we see developing during a proving could have actually have been interpreted in terms of an evolving drug disease, if proving information had been recorded in such a manner in the source books of our Materia Medica. Unfortunately, Hahnemann opted for the regional schema in his Materia Medica Pura which takes away the possibility of applying this concept to the earliest provings. What would this progression of time-expression in artificial drug disease (i.e., in the remedy proving) be? We begin with the Constitution (Normality) and move through the following miasmatic progression: > Diathesis –> Prodrome –> Psora  –> Sycosis –> Syphilis.

All proved medicines  of our Materia Medica produces symptoms in provers that could be studied according to the above progression. Might it not also be possible, keeping this progression in mind, to re-prove remedies today and document the resulting information in this fashion?

The Constitutional Remedy

Even homeopaths who treat according to the concept of the so-called “constitutional remedy” may remain confused about what exactly defines this remedy. Many haven’t a clue or have only a very vague concept; others consider the “constitutional remedy” to be the indicated chronic remedy.

It would be helpful at this stage to define the term “constitution” from a miasmatic point of view. This will clarify what we mean, speaking in terms of the concept of time-expression, when we use the term “constitutional” to define a chronic simillimum.

An individual consists of a psycho-biological apparatus (biological intelligence, intellect, emotion, spirit) involved in the constant struggle to maintain homeostasis. The quality of homeostasis is expressive of the individual’s biological, emotional, and spiritual needs. This psycho-biological apparatus (the human body) evolves in accordance with a codified genetic plan that unfolds progressively, in response to environmental factors, as each individual ages. Based on the immune system or the Psycho-Neuro-Immuno-Endocrine (PNIE) axis, the individual has the potential to survive adverse conditions and reach an adaptive balance which allows survival. This struggle is expressed in external physical signs and symptoms as well as mental symptoms. The homeopathic physician is concerned with understanding the characteristic individuality of this expression in order to find the simillimum, i.e., the single remedy which is matched to the presenting picture of disease symptoms in the patient.

A distinct homogeneous yet characteristic totality is expressed through presenting Symptoms and Concomitants (functional and structural) with an individualized response to various environmental factors known as Modalities. This is expressed at all levels: Body, Mind and Spirit. This homogeneous expression for adaptive balance or homeostasis is what we define as the Constitution of an individual.

The remedy that encompasses the diseased state of this constitutional expression at all levels, body, mind, and spirit, is what is termed “constitutional remedy“. It necessarily coincides with the miasmatic expression of the individual.

Diathesis is an exaggerated expression of the adaptive balance of the still-healthy constitution—a precarious balance of health, with morbid tendencies which predispose the individual towards disease.

The Disease state can be expressed in 3 phases: the pre-symptomatic phase –> prodrome phase –> nosological disease state. This movement continues along a particular course during an individual’s lifetime, with multi-miasmatic expression evolving, which ultimately ends in death. The disease state is inherent due to a fundamental miasm agents/changes in the environment act only as a spark or trigger.

What our great master says about the life style triggers in the following aphorism-

Aphorism 5

Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, the ascertainable physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function,  &c., are to be taken into consideration.

Suppression occurs by various means (drug-induced, physical agents, surgery, etc). It is vital to understand that suppression produces a change in the expected direction of the process of disease. This change is in the opposite direction of Hering’s Therapeutic Law of Direction of Cure. Suppression may cause one-sided cases; alternating states; complex disease; tardy convalescence or protracted recovery; addictions; periodic or episodic disease; paucity of symptoms; acute fulminating disease expression, etc. The only way to track the cure of a suppressed case is to take a complete history and then evaluate the results according to Hering’s Law of Cure, properly understood.

As stated earlier, disease progression in an individual is due to two main causes:

1. Environmental factors: Physical (sun, lunar energy, radiation, etc.), chemical (drugs, metals, occupational hazards, etc.), biological (bacteria, fungi, vaccinations, etc.), socio-cultural, emotional, and spiritual.
   2. The fundamental maintaining cause: The miasms – Psoric, Sycotic, and Syphilitic.

While environmental factors are seldom under our control as causative modalities, we have the ability with our remedies to modify the maintaining causes through our understanding of Miasms. In the subsequent notes, we will attempt to explain more fully how to recognize the (predominant) miasmatic expression in a particular individual and manage the case therapeutically to achieve true cure of chronic disease. All this must, however, be understood as according to Hering’s observations on the evolution of disease, which he says develops:

1.From the periphery to the center.
2.From the superficial to the deeper areas.
3.From the less vital to more vital organs.
4.From the characteristic to the common.
5.From  subjective to objective symptoms.

CURE thus takes place according to Hering’s Therapeutic Law of Direction of Cure, from center to periphery, within – outward, above – downwards, from organs of more importance to those of lesser importance, i.e., in REVERSE order of the chronological onset of symptoms.

True healing further implies an alignment of the biological intelligence and the emotion-desire complex with the intellect governed by the spirit.

APHORISM 204

If we deduct all chronic affections, ailments and diseases that depend on a persistent unhealthy mode of living, (Aph 77) as also those innumerable medicinal maladies (v.Aph 74) caused by the irrational, persistent, harassing and pernicious treatment of diseases often only of trivial character by physicians of the old school, most of the remainder of chronic diseases result from the development of these three chronic miasms, internal syphilis, internal sycosis, but chiefly and in infinitely greater proportion, internal psora, each of which was already in possession of the whole organism, and had penetrated it in all directions before the appearance of the primary, vicarious local symptom of each of them (in the case of psora the scabious eruption, in syphilis the chancre or the bubo, and in sycosis the condylomata) that prevented their outburst; and these chronic miasmatic diseases, if deprived of their local symptom, are inevitable destined by mighty Nature sooner or later to become developed and to burst forth, and thereby propagate all the nameless misery, the incredible number of chronic diseases which have plagued mankind for hundreds and thousands of years, none of which would so frequently have come into existence had physicians striven in a rational manner to cure radically and to extinguish in the organism these three miasms by the internal homoeopathic medicines suited for each of them, without employing topical remedies for their external symptoms. (see note to Aph 282)

The 3 great miasmatic constitutions (Psora, Sycosis, Syphilis) like all systems of classification are idealized, representative types. These miasmatic states do not exist in the pure form either in physical or emotional manifestation: life is always a mixture. When we understand these limits of classification, then we can employ them as convenient tools in case management.

PSORA
Hypersensitivity and reactivity in response to environmental stimuli are hallmarks of the Psoric miasm. The system gears itself towards restoring a healthy balance through quick, immediate, and adequate mobilization of the built-in natural defenses at its disposal. A clear example is how simple inflammatory processes resolve rapidly without suppuration and residue, removing all troublesome effects. Study of pathology today gives us clear details of the normal acute inflammatory process; this is what Psora is all about.

Thus, troublesome effects are restricted to the level of the skin and its appendages (the mucous membranes exposed to the environment) and to the level of the mind. Characteristic and classical eruptions and discharges are manifestations of Primary Psora and ideally should be seen in infancy and very early childhood.

When these expressions are blocked due to suppressive measures such as allopathic drugs, homeopathic palliation or suppression, or physical agents, there is a progressive internalization of the trouble towards more vital organs of metabolism, nutrition, glands, RES, CVS and CNS. This is secondary Psoric expression, the cardinal feature of which is functional changes with minimal structural alterations which are all reversible. These functional changes may include incoordinations and imbalances of functions, faculties and processes of the PNIE axis producing symptoms of congestion, dyskinesia of organs and systems, and nutritional disturbances of diverse types.

Hahnemann himself has given us a large number of examples of Psoric expression of symptoms in The Chronic Diseases. From a medical standpoint, all the miasmatic symptoms are functional in nature and follow most of the indications mentioned above about Psoric miasmatic expression. With our understanding of disease evolution, we will see that a few of the listed symptoms would ideally be classified into the Sycotic or Tubercular or Combined Miasmatic disease group.

This Psoric hypersensitivity is responsible for the individual features of Craving, Aversions, the Concomitants and reactions to environmental circumstance and time, which guide homeopathic prescribing.

It is important to remember that the Psoric sensitivity does not regress with the advent of Sycosis, Tubercle and Syphilis; it continues concomitantly with a variable course and intensity.

We are thus able to appreciate that the Hahnemannian Totality is an evolutionary one, spreading itself out in space through the four miasmatic expressions. Perceiving these parallel expressions is our aim in clinical management

SYCOSIS
An over-stimulated, hypersensitive, and responsive system under continuous bombardment by adverse environmental input is driven into disorientation, hence resulting in a slow-down of activity, with reduced Sympathetic activity and an increase in Parasympathetic activity. Now the system seems to be losing control, leading to inefficient and aberrant immune responses and progressively inefficient metabolic processes. This ultimately results in a system with increasing inertia. The acute inflammatory response has shifted to a chronic inflammatory response which is slow and can be inadequate in the long term.

Hahnemann left a large lacuna in his description of the sycotic miasmatic expression. It would seem a more likely and logical conclusion that the sycotic expression developed into a hydra-headed monster as well, over centuries of suppressive treatment. An obvious extrapolation of the sycotic state is that the system, having been pushed into lethargy, mounts a response that seeks to conserve energy or create slow (aberrant) defenses against adverse environmental stimuli.

General expressions:

• Anemia, refractory to haematinics
• Weakness disproportionate and unaccountable, aggravated by suppression of discharges
• Fatigue causing slowness, dullness, sluggishness of all processes at the level of intellect, emotions, and body.
• RES aberration in recognition of self and non self leading to excessive and uncontrolled proliferation of tissue

Altered Physical Expression:
The physical responses in sycosis are erratic, wandering, sudden, intense, spasmodic (cramps, colic, asthma) and remote metastatic non-suppurative inflammatory reactions. Metastatic means that inflammatory processes continue chronically in organs distant from the area where the original infection took place. The hallmark of the sycotic expression is a tendency to overgrowth (benign tumours) and accumulation of fluid (cysts, swellings) in any disease activity in the body. These are expressions of indolence and sluggishness of different metabolic processes and bio-feedback mechanisms, and a general laxity of the system.

SYPHILITIC
The long, drawn-out evolution of miasmatic disease expression finally terminates in syphilitic expression which is characterized by destruction at all levels.

Treponema pallidum, the clinical cause of the disease syphilis is one of the typical expressions of the syphilitic miasmatic expression.

Some of the indicators that suggest a syphilitic diathesis in the past history or family history are:

• History or evidence of clinical syphilis
• Repeated abortions or miscarriages, still births, neonatal deaths, fetal malformations, placenta praevia, vesicular mole, toxemia of pregnancy
• Cancer
• Ectopic tissues (ectopic gestation, mammae, thyroid, uterine endometrium)

This means that if a patient has symptomatology that resembles the clinical features of classical syphilis, we can presume the presence of a strong syphilitic diathesis. When there is a strong hereditary and historical background for this, the syphilitic miasmatic expression is induced very early in life. There is a rapid miasmatic transition with  phases of all other miasms expressed fleetingly before Syphilis manifests,  either after birth or even during intrauterine life. This explains how a short phase of psoric expression can suddenly jump to a syphilitic miasmatic expression such as terminal malignancy in infants or congenital malformations.

Violence is the hallmark of the syphilitic response throughout. It is irrational and dis-proportionate, relentlessly driving toward destruction at all levels from the spirit to the intellect, the emotions as well as the body. There is an erosion of values of life where base-impulses have their full sway. Manic psychosis, psychopathic personalities, criminal propensities, moral depravity, etc., are all examples of this destruction. The violence and destruction at the physical level are more reliable indicators of a miasmatically predominant syphilitic expression. This is expressed in the following types of symptomatology:

Auto-Immune Disorders: These terminate in the syphilitic expression when there is organ degeneration or loss of function, though the earlier phases may be either sycotic or tubercular.

COMBINED MIASMS
Disease response is found to evolve over time and is a multi-miasmatic process. Individuals often present a Combined Miasmatic Disease Expression in any number of permutations and combinations, although at any given point of time, one miasmatic expression predominates. If a practitioner faithfully records the anamnesis, he will notice this evolution of disease expression. It is the characteristic concomitants at any given point in time that are essential for establishing the simillimum in each instance. We rarely find one remedy running through all phases. A complete analysis of the details will give the knowledgeable homeopathic physician a clear mapping of what to expect in the future in terms of remedy choices.

A miasmatically valid totality is built up by patiently collecting data of the entire life history of the patient, stressing the chronological aspects in proper sequence, as well as all other aspects necessary for choosing a remedy. This alone permits the complete Planning and Programming of Homeopathic Treatment right at the outset. This includes the first prescription, the acute totalities with corresponding remedies for each, the chronic totality and the intercurrent totalities based on miasmatic predispositions which do not appear to be covered by the main, well-chosen constitutional remedy.

Clinical management based on the evolution of disease expression

APHORISM 205

The homoeopathic physician never treats one of these primary symptoms of chronic miasms, nor yet one of their secondary affections that result from their further development, by local remedies (neither by those external agents that act dynamically, 118 nor yet by those that act mechanically), but he cures, in cases where the one or the other appears, only the great miasm on which they depend, whereupon its primary, as also its secondary symptoms disappear spontaneously; but as this was not the mode pursued by the old – school practitioners who preceded him in the treatment of the case, the homoeopathic physician generally, alas! finds that the primary symptoms 119 have already been destroyed by means of external remedies, and that he has now to do more with the secondary ones, i.e., the affections resulting from the breaking forth and development of these inherent miasms, but especially with the chronic diseases evolved from internal psora, the internal treatment of which, as far as a single physician can elucidate it by many years of reflection, observation and experience, I have endeavoured to point out in my work on Chronic Diseases, to which I must refer the reader.

APHORISM 206

Before commencing the treatment off a chronic disease, it is necessary to make the most careful investigation 120 as to whether the patient has had a venereal infection (or an infection with condylomatous gonorrhoea); for then the treatment must be directed towards this alone, when only the signs of syphilis (or of the rarer condylomatous disease) are present, but this disease is seldom met with alone nowadays. If such infection have previously occurred, this must also be borne in mind in the treatment of those cases in which psora is present, because in them the latter is complicated with the former, as is always the case when the symptoms are not those of pure syphilis; for when the physician thinks he has a case of old venereal disease before him, he has always, or almost always, to treat a syphilitic affection accompanied mostly by (complicated with) psora, for the internal itch dyscrasia (the psora) is far the most frequent (most certain) fundamental cause of chronic diseases, either united (complicated) with syphilis (or with sycosis), if the latter infections have avowedly occurred. At times, both miasms may be complicated also with sycosis in chronically diseased organisms, or, as is much more frequently the case, psora is the sole fundamental cause of all other chronic maladies, whatever names they may bear, which are, moreover, so often bungled, increased and disfigured to a monstrous extent by allopathic unskillfulness.

APHORISM 207

When the above information has been gained, it still remains for the homoeopathic physician to ascertain what kinds of allopathic treatment had been up to that date adopted for the chronic disease, what perturbing medicines had been chiefly and most frequently employed, also what mineral baths had been used and what effects these had produced, in order to understand in some measure the degeneration of the disease from its original state, and, where possible, to correct in part these pernicious artificial operations, or to enable him to avoid the employment of medicines that have already been improperly used.

APHORISM 208

The age of the patient, his mode of living and diet, his occupation, his domestic position, his social relations and so forth, must next be taken into consideration, in order to ascertain whether these things have tended to increase his malady, or in how far they may favour or hinder the treatment. In like manner the state of his disposition and mind must be attended to, to learn whether that presents any obstacle to the treatment, or requires to be directed, encouraged or modified.

APHORISM 209

After this is done, the physician should endeavour in repeated conversations with the patient to trace the picture of his disease as completely as possible, according to the directions given above, in order to be able to elucidate the most striking and peculiar (characteristic) symptoms, in accordance with which he selects the first antipsoric or other remedy having the greatest symptomatic resemblance, for the commencement of the treatment, and so forth.

Relative to acute disease expression, we know that:

1. Acute diseases (dissimilar disease) supervene during the course of chronic disease, or
2. Acute diseases are actually acute exacerbations of a chronic disorder, or
3. Acute phase expressions of a periodic disease, e.g.: asthma.

In type 1, an acute remedy is required. When it completes its action, the constitutional symptoms become more prominent and the chronic or constitutional remedy is then indicated. Premature prescription of the constitutional remedy would produce an aggravation of the acute symptoms. It is thus clear that Time is of vital importance for a physician.
More often than not, type 2 and type 3 require only the chronic or constitutional remedy to control the acute problem and continue progress towards cure.

As Dr.Stuart Close has said

   In cases of renal or hepatic colic, for example: If the physician is firm and calm as well as skillful, and possesses the entire confidence of the patient and his family and friends, he may be able to alleviate the agonizing pain and carry such cases through to a happy termination by the use of homœopathic remedies alone. It has often been done and, when possible, is the ideal way.

HOMOEOPATHIC MEDICINES—Number of Homoeopathic medicines are effectively used to treat the cases of urolithiasis ,may briefly be summarized as :-

BERBERIS VULGARIS:  Bark of root is used to prepare medicine , which contain active gradient Berberine and oxycanthine. Which gives following symptoms

According to Henary Guernsey                                                                          

This remedy affects particularly the lumbar region; kidneys; uterus. The patient is sometimes unable to tell the exact locality, but the pain is somewhere in the back, and shoots up the back; or into the spermatic cord, or testes, bladder, buttocks, or legs. The pain may shoot up or down, or both ways. Pains all over the body, emanating from the region of the back; sticking, pinching, pricking lancinating or jerking character, flying about, now here and now there. There is often a bubbling sensation in the region of the kidneys; this sensation may occur elsewhere, but it is usually found here.

According to J.T.Kent

Burning and soreness in the region of the kidneys. Burning stitches, single or several in succession, in regions of loins and kidneys. Much pain, soreness and tenderness in back, in the region of the kidneys. Sensitiveness in the region of the kidneys so great that any jarring motion, riding in a wagon, jumping from it, was intolerable. After kidney complaints, a foul, bitter taste, rush of blood to the throat. Great urging, with pain in the neck of the bladder, with burning, scanty urine. Violent, cutting, tensive pain, deeply seated in left side of bladder, at last becoming a sticking, obliquely in female urethra, as if in its orifice, lasting a ‘few minutes.

• Left side kidney stone with bubbling sensation
• Inflammation of kidney , haematuria
• Radiating type of pain from abdomen to hips and groin and to urethra
• Frequent urination ,with numbness , stiffness and lameness feeling

HYDRANGEA  ARBORESCENE : Rhizome and roots are used to prepare medicine ,which contain glycosides ,saponins ,resins ,rutins ,essential oils ,and flavonoids. Which produces following symptoms

• White gravel comes in urine
• Chiefly indicated in left ureteric calculi
• Spasmodic stricture
• Burning in urethra with frequent desire

OCIMUM CANUM : Leaf is used to prepare medicine which contain terpenoids ,eugenol ,thymol ,and estragole.

• Uric acid diathesis
• Red sand in urine with high acidity and albuminous sediments
• Renal colic especially right side
• Chiefly indicated in right side ureteric stone
• Saffron yellow urine

SARSAPARILLA :Rhizome and roots are used to prepare medicine ,which contains steroidal saponins.

• Severe pain at conclusion of urine
• Child screams before and after passing urine
• Offensive smell of urine and genitals
• Severe strangury as in case of stone

PAREIRA BRAVA : Roots are used to prepare medicine , which contains bisbenzylisoquinoline alkaloids.

• Black bloody urine ,brick red sediment with a strong ammoniacal smell
• Catarrh of bladder constant urging great straining pain down thighs during efforts to urinate.
• Sensation as if bladder was distended
• Can emit urine  only  when  he goes on his  knees,  pressing  head  firmly against  the floor

NUX VOMICA:

• Irritable bladder; from spasmodic sphincter.   Frequent  calls; little  and    Haematuria.
• Ineffectual urging, spasmodic  and
• Renal colic  extending  to genitals,  with  dribbling urine.
• While urinating,  itching  in urethra and pain in neck of bladder.

LYCOPODIUM :

• Pain in  back  before urinating; ceases  after  flow;  slow  in coming,  must
• polyuria  during  the  night.
• Heavy red sediment.
• Child cries before urinating.
• It is mainly right sided medicine

CALCARIA CARB :

• Dark, brown, sour, fetid, abundant, with white sediment, bloody.
• Irritable bladder.   (use 30th, also Tuberculin, 1 m.)

CALCARIA RENALIS :

• It can break the tendency of recurrent stone formation

THLASPI BURSA PASTORIS_CAPSELLA :

• Frequent desire;  urine heavy, phosphatic.   Chronic
• Dysuria and spasmodic retention.
• Accumulation of
• Renal colic. brick-dust sediment.
• Urethritis;  urine runs  away  in  little    Often  replaces  the  use  of  the catheter.

SOLIDAGO VIRGA:

• Scanty, reddish  brown,  thick  sediment,   dysuria,
• Difficult And Scanty. Albumen, blood, and slime in urine.
• Pain in kidneys extend forward to abdomen and bladder.
• Clear and offensive
• Sometimes makes the use of the  catheter unnecessary.

ARNICA MONTANA :

• Retained from over-exertion. Dark brick-red sediment.
• Vesical tenesmus with very painful micturition.

BELLADONNA:

• Acute urinary infections.  Sensation of  motion  in bladder  as  of a worm.
• Urine scanty, with tenesmus;  dark  and turbid,  loaded  with     Vesical  region   sensitive.
• Incontinence, continuous     frequent   and   profuse.
• Haematuria where  no  pathological  condition  can  be
• Prostatic hypertrophy.

BENZOIC ACID :

• Repulsive Odor;  changeable  color;  brown,
• Enuresis; dribbling, offensive  urine of old men.  Excess  of  uric
• Vesical catarrh from suppressed gonorrhoea.

CANTHARIS :

• Intolerable Urging and tenesmus.  Nephritis with bloody
• Violent paroxysms of cutting and burning in whole renal  region, with   painful  urging  to  urinate;  bloody  urine,  by
• Intolerable tenesmus; cutting before, during, and  after
• Urine scalds him, and is passed drop by drop. constant desire to urinate.
• Membranous scales looking like bran in
• Urine jelly-like, shreddy.

EPIGEA :

• Chronic cystitis,  with dysuria;  tenesmus  after  micturition;
• Muco-Pus And Uric-Acid Deposit, gravel, renal calculi.
• Fine sand in urine  of a brown color.  Burning in neck of  bladder  whilst urinating  and  tenesmus afterward.
• Pyelitis, incontinence  of urine.  Croaking noise and rumbling in bowels.

THUJA :

• Urethra swollen,    Urinary stream  split  and  small.
• Sensation of trickling after urinating.  Severe  cutting
• Frequent micturition accompanying pains. Desire  sudden and  urgent,  but  cannot  be
• Paralysis sphincter vesicae.

UVA URSI :

• Frequent urging,  with severe spasms of  bladder;  burning  and tearing
• Urine contains blood, pus, and  much  tenacious mucus,  with  clots in large masses.
• Involuntary; green    Painful dysuria.

Role of other pathies in the treatment of urolithiasis

Ayurvedic drugs in the management of urolithiasis

Urolithiasis has been discussed elaborately in ancient Ayurvedic texts. Susruta, the father of surgery was of the view that the dietary factors are much more responsible for the calculi formation in the urinary tract – Mutrasmari.

Ayurvedic drugs like sveta parpati with pasanabheda and goksuru are very good in management of urolithiasis.

Urolithiasis and phytotherapy

The effects of seven plants with suspected application to prevent and treat stone formation in kidney

• Verbena officinalis,
• Lithospermum officinale,
• Taraxacum officinale ,
• Equisetum arvense ,
• Arctostaphylus uva – ursi ,
• Arctium lappa , and
• Silene saxifraga

have been studied using female wistar rats.It has been found that these herbs are very much beneficial in the treatment of urolithiasis

BIBLIOGRAPHY

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Dr Jitendra Kumar Srivastava (B.H.M.S., C.F.N. )
Sushila Homoeopathic Health Care and Research Center
4/146 New Azad Nagar Kanpur Uttar Pradesh India
Pin : 208011
Email : drjitendra2002batch@gmail.com