Leucorrhoea and its scope in homoeopathy

Dr Varsha Manchanda

ABSTRACT :
Leucorrhoea is one of the most common problem encountered in gynaecological practice. Due to this female often feels embarrassed in font of others and it also has a deep impact on her mental health. Homoeopathy being holistic in its approach not only focuses in the treatment of leucorrhoea but will also consider overall quality of life of the patient, providing her both physical and mental relief. This article focuses on the pathophysiology, causes, sign and symptoms , homoeopathic aspect, miasmatic analysis, repertorial approach and homoeopathic management of leucorrhoea on the basis of strict homoeopathic principles.

Keywords : Leucorrhoea, Homoeopathy, Organon, Rubrics, Therapeutic

INTRODUCTION
Leucorrhoea is defined as an excessive normal vaginal discharge. The symptom of excessive discharge varies from individual to individual and to declare it to be normal and not infective one, requires clinical and laboratory investigations.

The term leucorrhoea must fulfil the following criteria:

• The excess secretion can be seen from vulval moistness or staining of the undergarments (brownish yellow on drying) or need to wear a vulval pad.
• It is non-purulent and non-offensive.
• It is non-irritant and never causes pruritus. ⁽¹⁾

Every woman has normal vaginal discharge periodically, which maintains the chemical balance and flexibility of the vaginal muscles, serves as a normal defense system for the vagina. If the discharge is more than usual and becomes a thick, white or yellow liquid with a foul smell, it is called “leukorrhea,” which could be a sign of infection or any other causes .

The World Health Organization (WHO) has recommended the syndromic management  in which women complaining of vaginal discharge are treated for some or all of the five common reproductive tract infections like Chlamydia trachomatis, gonorrhea and trichomoniasis are sexually transmitted diseases and bacterial vaginosis and candidiasis, which are the result of disruption of the normal flora of the vagina^{. (2)}

Pathophysiology ⁽¹⁾
The physiological basis for normal vaginal discharge depends on estrogen levels. With rise in estrogen levels, the secretory activity of the endocrine glands becomes abundant, and the vaginal surface epithelium becomes rich in glycogen. The secretion of mucus by the cervical glands is usually weak. The carbohydrate component of the  glycoprotein mucin splits and  fermented to lactic acid. However, if the mucus is too much, it will come out at the level of the vulva.

The excessive secretion is due to: ⁽¹⁾

1. Physiologic excess
2. Cervical cause (cervical leucorrhoea)
3. Vaginal cause (vaginal leucorrhoea)

 

1. Physiologic excess: The normal secretion is expected to increase in conditions when the estrogen levels become high. Such conditions are :

During puberty—Increased levels of endogenous estrogen lead to marked overgrowth of the endocervical epithelium which may encroach onto the ectocervix producing congenital ectopy (erosion) →increased secretion.

During menstrual cycle

• Around ovulation—Peak rise of estrogen →increase in secretory activity of the cervical glands.
• Premenstrual pelvic congestion and mucus secretion from the hypertrophied endometrial gland is increased.

Pregnancy—There is hyperestrinism with increased vascularity. This leads to increased vaginal transudate and cervical gland secretion.

During sexual excitement, when there is abundant secretion from the Bartholin’s glands.

2. Cervical cause: Non-infective cervical lesion may produce excessive secretion, which pours out at the vulva. Such lesions are—cervical ectopy, chronic cervicitis, mucous polyp and ectropion.
3. Vaginal cause: Increased vaginal transudation occurs in conditions associated with increased pelvic congestion. The conditions are uterine prolapse, acquired retroverted uterus, chronic pelvic inflammation, ‘pill’ use and vaginal adenosis. Ill health is one of the important causes of excessive discharge.

Other causes which may be responsible to develop white discharge :

• Hormonal imbalance especially oestrogen imbalance
• Spread of infection from urinary tract
• Early/young age pregnancy
• Ill health and poor hygiene
• Chronic sickness
• Diabetes and anaemia or any systemic disease which lowers immunity.
• Mental anxiety and sexual frustration.

Sign and Symptoms :

Signs and symptoms point to the specific disease diagnosis of the underlying causative factors. Thus, medical evaluation is further required, if a women suffers from any of the following sign and symptoms :

• Intense itching of the vulva
• Soreness of the vulva
• Unusual vaginal discharge
• Fish-like smelly discharge
• Yellowish or thick curd-like discharge
• Vaginal bleeding in between two menstrual cycles
• Severe pain or menstrual-like cramps in the lower part of the abdomen
• Pain during or after sex
• Bleeding during or after sex
• Pain while passing urine
• Vaginitis
• Skin lesions around the vagina
• Vulvae edema (swelling of the vagina)
• Lower back pain.

Diagnosis and Investigation of Patient with Vaginal Discharge : ⁽³⁾

General examination may reveal ill health.

Vulval inspection reveals: white or creamy discharge, no evidence of pruritus.

Inspection of the vagina and cervix by speculum and microscopy of a fresh wet specimen of the discharge will usually provide enough information for the diagnosis to be made and for treatment to be instituted. It reveals: either a negative pathology, associated pelvic lesion mentioned earlier causing cervical or vaginal leucorrhoea.

To exclude the infective nature, microscopic examination is done for detection of pus cells, if pus cells are not detected- true leucorrhoea. If pus cells are not detected, the following examination should be done to identify the organism from the discharge. These are :

• Hanging drop preparation-Reveals presence of motile trichomonas organisms
• Gram stain-This may reveal presence of gram negative intracellular and extracellular diplococci suggestive of gonococci, Clue cells suggestive of bacterial vaginosis.
• Culture-
• Chocolate Agar-Gonococci
• Sabouraud’s medium or Nickerson’s medium Candida
• Special enriched medium-Trichomonas.
• Trichomonas infection.

Homoeopathic aspect towards Leucorrhoea : ⁽⁴⁾⁽⁵⁾

• Any discharge that is not blood is called leucorrhoea It is not a disease, but the product of diseased state or condition of the system. Clinically we have 4 categories of leucorrhoea:

Vulvar	Vaginal	Cervical	Uterine
MC in children and in aged women	During child bearing period, in young women.	During child bearing period	During child bearing period.
Sero-purulent discharge, viscid, unctuous, having an odour of old cheese.	Creamy & purulent,  it may be either bland or excoriating discharge.	Thick, tenacious, ropy, or stringy and albuminous.	More watery than cervical; may be tinged with blood or mixed with pus.

 

• By the homoeopathic point of view we find that with every case the phenomena of some chronic miasm, active or latent in the organism, slumbering by virtue of the presence of the leucorrhoeal discharge or awakened by its suppression. Dr. A C Cowperthwaite stated that ; “The constitutional or symptomatic treatment of leucorrhoea is of the greatest importance. It must be continually borne in mind that leucorrhoea is, in itself, but a symptom, either of some constitutional dyscrasia or of some local existing causes.” ⁽⁴⁾
• Dr Hahnemann has stated in footnote to Aphroism 94 that in chronic diseases of female it is specially necessary to pay attention to; “ if there is leucorrhoea, what is its nature, what sensations  attend its flow, in what quantity it is ,and what are the conditions and occasions under which it occurs ? ” ⁽⁵⁾

Miasmatic Analysis of Leucorrhoea–  ⁽⁴⁾

• Psoric discharge – whitish albuminous, odourless and usually bland.
• Sycotic discharge – is thin, greenish yellow or dark, like dirty water , acrid and excoriating in nature and produces pruritis of the parts passed over.The odour is pungent, musty like fish brine or stale fish.
• Syphilitic discharge- may be thin, mixed with blood or may found with any malignancy. It odours foul.
• Tubercular discharge is- thick, yellowish, creamy or greenish-yellow. It often has a sweetish odour.

The rubric Leucorrhoea from different repertories :

[Kent ] [Genitalia female]LEUCORRHOEA: ⁽⁶⁾

2 Aesc, 1 Agar, 1 Agn, 2 Alet, 3 Alum, 1 Alumn, 2 Am-c, 2 Am-m, 1 Ambr, 1 Anac, 1 Ant-c, 1 Apis, 2 Arg-n, 3 Ars, 3 Ars-i, 1 Asaf, 1 Aur, 2 Aur-m, 1 Aur-m-n, 1 Bad, 2 Bar-c, 2 Bar-m, 1 Berb, 2 Bor, 2 Bov, 1 Bry, 3 Calc, 2 Calc-p, 3 Calc-s, 1 Cann-s, 1 Canth, 1 Caps, 3 Carb-an, 2 Carb-v, 3 Carbn-s, 1 Card-m, 1 Caul, 3 Caust, 1 Cedr, 1 Cham, 1 Chel, 2 Chin, 1 Chin-ar, 2 Cimic, 2 Cinnb, 2 Cocc, 1 Coff, 1 Con, 1 Crot-c, 1 Cub, 1 Cur, 1 Cycl, 1 Dig, 1 Dros, 1 Dulc, 2 Eupi, 2 Ferr, 1 Ferr-ar, 1 Ferr-p, 2 Gels, 3 Graph, 1 Guai, 1 Ham, 1 Helon, 2 Hep, 1 Hura, 2 Hydr, 3 Iod, 1 Ip, 3 Kali-ar, 2 Kali-bi, 3 Kali-c, 2 Kali-chl, 2 Kali-i, 2 Kali-p, 2 Kali-s, 3 Kreos, 2 Lac-c, 2 Lach, 1 Laur, 1 Lil-t, 2 Lyc, 2 Lyss, 1 Mag-c, 2 Mag-m, 1 Mag-s, 1 Mang, 3 Med, 3 Merc, 2 Merc-c, 1 Merc-i-f, 1 Merc-i-r, 1 Mez, 3 Mur-ac, 1 Murx, 2 Nat-ar, 2 Nat-c, 1 Nat-hchls, 3 Nat-m, 2 Nat-p, 1 Nat-s, 3 Nit-ac, 2 Nux-m, 1 Nux-v, 2 Op, 2 Orig, 2 Pall, 2 Petr, 2 Ph-ac, 2 Phos, 2 Phys, 2 Phyt, 3 Plat, 1 Plb, 2 Podo, 1 Prun, 2 Psor, 3 Puls, 1 Ran-b, 1 Rat, 1 Rhus-t, 1 Ruta, 2 Sabin, 1 Sang, 1 Sarr, 2 Sars, 1 Sec, 1 Senec, 1 Seneg, 3 Sep, 3 Sil, 1 Squil, 3 Stann, 1 Stront, 2 Sul-ac, 3 Sulph, 1 Syph, 2 Tarent, 2 Thuj, 1 Til, 1 Ust, 1 Viol-t, 2 Zinc

[Boenning ] [Menstruation]LEUCORRHOEA: In general:⁽⁷⁾

2 Acon, 2 Agn, 4 Alum, 3 Am-c, 1 Am-m, 2 Ambr, 2 Anac, 1 Ant-c, 1 Ant-t, 1 Arg-n, 2 Ars, 1 Bar-c, 1 Bell, 2 Bor, 2 Bov, 1 Bry, 4 Calc, 1 Calc-p, 2 Cann-s, 2 Canth, 3 Carb-an, 3 Carb-v, 3 Caust, 2 Cham, 3 Chin, 4 Cocc, 1 Coff, 4 Con, 2 Dros, 3 Ferr, 3 Graph, 1 Guai, 2 Hep, 1 Ign, 2 Iod, 3 Kali-c, 1 Kali-n, 4 Kreos, 2 Lach, 3 Lyc, 3 Mag-c, 3 Mag-m, 1 Mang, 4 Merc, 3 Mez, 1 Mur-ac, 3 Nat-c, 3 Nat-m, 2 Nit-ac, 1 Nux-m, 3 Nux-v, 3 Petr, 2 Ph-ac, 3 Phos, 1 Plat, 1 Plb, 4 Puls, 1 Ran-b, 2 Ruta, 3 Sabin, 1 Sars, 3 Sec, 1 Senec, 4 Sep, 3 Sil, 1 Squil, 3 Stann, 1 Stront, 2 Sul-ac, 3 Sulph, 1 Thuj, 1 Viol-t, 3 Zinc

[Boericke ] [Female Sexual System]LEUCORRHOEA, REMEDIES IN GENERAL: ⁽⁸⁾

2 Agar, 3 Agn, 3 Alet, 2 Aln, 3 Alum, 2 Am-c, 3 Am-m, 3 Ambr, 2 Arg-n, 3 Ars, 2 Asaf, 2 Aur-m, 3 Aur-m-n, 2 Bar-m, 2 Baros, 2 Bell, 3 Bor, 3 Bov, 3 Calc, 3 Calc-o-t, 2 Calc-p, 3 Canth, 2 Carb-v, 3 Caul, 2 Caust, 2 Cham, 2 Cimic, 3 Cinch, 3 Coc-c, 3 Con, 3 Cop, 3 Dict, 3 Eucal, 2 Eupi, 2 Ferr-i, 3 Frax, 2 Gels, 3 Graph, 2 Hedeo, 2 Helin, 3 Helon, 2 Hep, 3 Hydr, 2 Hydrc, 2 Ign, 2 Iod, 2 Jac, 2 Joan, 3 Kali-bi, 3 Kali-c, 2 Kali-m, 3 Kali-s, 3 Kreos, 3 Lil-t, 3 Lyc, 2 Mag-c, 3 Mag-m, 3 Merc, 2 Merc-pr-r, 2 Mez, 2 Murx, 2 Naja, 3 Nat-m, 3 Nat-s, 3 Nit-ac, 2 Nux-v, 2 Orig, 2 Pall, 2 Pic-ac, 3 Psor, 3 Puls, 2 Pulx, 3 Sabin, 3 Sec, 2 Sil, 2 Spira, 3 Stann, 2 Sul-ac, 2 Sulph, 2 Thlaspi, 3 Thuj, 2 Til, 2 Tril, 2 Vib, 3 Xanth, 2 Zinc-m

[Boger ] [Genitals] LEUCORRHOEA: ⁽⁹⁾

1 Alum, 1 Calc, 1 Kreos, 2 Merc, 1 Nat-m, 1 Puls, 2 Sep

[Phatak ] [Phatak A-Z] LEUCORRHOEA:⁽¹⁰⁾

2 Alum, 1 Ars, 1 Calc-s, 1 Carb-an, 1 Caust, 2 Graph, 1 Hydr, 1 Iod, 1 Kali-c, 2 Kreos, 1 Med, 3 Merc, 2 Nat-m, 1 Nit-ac, 1 Plat, 2 Puls, 3 Sep, 1 Sil, 1 Stann, 1 Sulph

[Therap ] [Leucorrhoea] LEUCORRHOEA:In general: ⁽¹¹⁾

1 Acon, 3 Aesc, 1 Agn, 4 Alum, 3 Am-c, 1 Am-m, 1 Ambr, 1 Anac, 1 Ant-c, 1 Ant-t, 3 Ars, 1 Bar-c, 1 Bell, 2 Bor, 3 Bov, 1 Bry, 4 Calc, 2 Calc-p, 1 Cann-s, 2 Canth, 2 Carb-an, 3 Carb-v, 2 Caul, 1 Caust, 2 Cedr, 2 Cham, 2 Chel, 3 Chin, 2 Cinnb, 3 Cocc, 1 Coff, 3 Con, 2 Cub, 1 Dros, 3 Ferr, 3 Graph, 1 Guai, 1 Hep, 2 Hydr, 1 Ign, 2 Iod, 2 Kali-c, 1 Kali-n, 4 Kreos, 3 Lyc, 2 Mag-c, 1 Mag-m, 1 Mang, 4 Merc, 2 Merc-i-r, 2 Mez, 1 Mur-ac, 2 Nat-c, 2 Nat-m, 2 Nit-ac, 1 Nux-m, 1 Nux-v, 1 Petr, 3 Ph-ac, 3 Phos, 1 Plat, 1 Plb, 4 Puls, 1 Ran-b, 2 Rhus-t, 2 Ruta, 3 Sabin, 1 Sars, 1 Sec, 1 Seneg, 4 Sep, 3 Sil, 1 Squil, 2 Stann, 1 Stront, 2 Sul-ac, 3 Sulph, 2 Tarent, 2 Thlaspi, 3 Thuj, 1 Viol-t, 3 Zinc

Therapeutics of Leucorrhoea : ^(12)(13)

• Kreosotum- putrid leucorrhoea which causes swelling and it often corrodes the parts passed over, and there is itching as well as biting externally; leucorrhoea is exhausting; it may be milky, whey-like, or yellow. It stains the linen yellow and it stiffens like starch, with great weakness . The odour of discharge is like green corn & accompanied with pain in small of back. Leucorrhoea is worse between periods.
• Ammonium muriaticum- Adapted to despondent, suicidal and sanguine temperaments; muddy complexions, light haired women or girls at puberty. Leucorrhoea is profuse yellow or white, thick, corrosive, with burning and smarting sensation. It often excoriates the whole perineum and inner surface of thighs. Leucorrhoea is like white of an egg , brown, slimy, painless and often noticed after every urination.
• Apis mellifica- Cutting and stinging pain in the right ovary; adapted to frivolous and jealous girls, who, though generally cautious and careful, drop things or let them fall while handling them. Leucorrhoea is profuse, yellow or green and acrid, along with stinging sensation in the perineum.
• Borax – Discharge like white of an egg with sensation as if warm water were flowing down. Leucorrhoea profuse, albuminous, starchy. For two wee between the catamania.
• Calc carbonica- In infants and before puberty. Discharge like milk and itching and burning, worse immediately before menses; too early and profuse menses. Corrosive leucorrhoea in young children.
• Graphitis – discharge very thin, watery white mucus, occurring in gushes day and night, often acrid and excoriating, great weakness in small of back when walking or sitting; before and after menses.
• Hydrastis -Leucorrhoea worse after menses; acrid and corroding, shreddy, tenacious, ropy, thick, yellow, viscid; Hanging from os in long strings. Great weakness, constipation, pruritus vulva with profuse leucorrhoea.
• Kalium Bichromicum- A yellow , ropy, stringy leucorrhoea .It is suitable to fat, light haired persons.
• Lilium tigrinum – Bearing down sensation with desire for stool, as though all organs would escape. Constant desire to support parts externally. Leucorrhoea is acrid and brown. Leucorrhoea ceases when resting and there is smarting pain in labia.
• Pulsatilla- Discharge thick like cream or milky; thick yellowish and bland but sometimes corrosive and burning with itching of parts. Thick, white mucus; discharge taking place immediately before during and after menstruation.
• Sepia- discharge like milk, only in daytime; with soreness of pudenda. Cheesy or curd like discharge, which is horribly offensive. Ball like sensation in vagina and uterus along with leucorrhoea and other uterine troubles.

CONCLUSION
Leucorrhoea is major problem encountered in gynaecological OPDs. Many factors are responsible for it i.e. ill health, bad hygiene, sedentary life, hormonal imbalances, menstrual irregularities, mental stress and so on. Homoeopathy plays a significant role in treatment of leucorrhoea in comparison to other conventional treatment . Homoeopathy focuses in treating the individual in disease , not the disease .Homoeopathy treats the  patient as a whole ; taking note of causative factors, signs and symptoms, accessory circumstances, miasmatic background in framing the totality of symptoms for the purpose of individualisation which helps in the selection of similimum. Homoeopathy medicines prescribed on the basis of homoeopathic principles proved to be highly efficacious in bringing about the cure.

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Dr Varsha Manchanda
MD Scholar (Government Homoeopathic Medical College, Bhopal)
Department of Organon of Medicine and Homoeopathic Philosophy