Leucorrhoea: Concepts and Homoeopathic Approach with Kent’s Repertory

Leucorrhoea: Concepts and Homoeopathic Approach with Kent’s Repertory

Dr Saurabh Kumar Sobhari

ABSTRACT
Health of women is considered to be the backbone of the family and society. If she is Healthy, Family will be wealthy and successful in every manner. Reproductive tract infections / diseases are one among the major causes of morbidity in women. Now a day, there is a growing recognition that morbidity related to excessive normal and abnormal vaginal discharge is the important health issue among women in India. Women are not only embarrassed in front of others because of this, but it also has deep impact on the patient’s mental health. Most of them avoid discussing the problem with their medical health care providers, which is why the treatment for vaginal discharge could be a bit of challenge.

Apart from this, As a physician we still found difficult to cure this common morbid state because we couldn’t understand various aspect related to this, although there is lot of work (clinical aspect/ approaches to treat) done before this but I found it partial which is difficult to understand for a new homoeopath.

There may be various approaches to studying and to cure vaginal discharge, here in this article I’m trying to summarize the various issues related to this common problem on various grounds as clinical aspect, homoeopathic philosophical aspect, miasmatic cleavage, rubric characteristics arrangement in widely used Kent repertory.

Introduction

Synonyms fluor albus, Whites. The word leucorrhoea comes from Greek (leukós, “white”) + (rhoía, “flow, flux”). In Latin leucorrhoea is fluor albus.

Vaginal discharge is not always abnormal. Leucorrhoea is defined as excessive normal vaginal discharge. Excess secretion should evident from staining of the undergarments. Discharge is watery, white, non-odorous, non-purulent, non-irritant, with acidic nature and never causes pruritus but changes in character of discharge is abnormal and due to many other causes as infection, malignancy, and hormonal changes etc. 

Physiological leucorrhoea
The term is used to refer to leucorrhoea due to estrogen stimulation. It can be a natural defense mechanism that the vagina uses to maintain its chemical balance, as well as to preserve the flexibility of the vaginal tissue.

Cervical Leucorrhoea
Non infective cervical lesions may produce excessive secretions eg. Chronic cervicitis, cervical erosions, cervical ectopy, cervical mucus polypi, and polyp ectropion (cervical glands exposed to vagina). Discharge is mucoid at external os on speculum examination.

Vaginal leucorrhoea
It occurs when there is increase pelvic congestion eg. Pill uses, uterine prolapse, PID, vaginal adenosis or retroverted uterus and chronic systemic illness or due to increase level of estrogen which leads to excessive shedding of keratinized cell of vagina. 

History / Examination / Investigations
We should write down all complaints with their characteristic onset, duration, sensations, character of discharge, modifying factors along with associated complaints. H/O should involve sexual behavior, contraception methods, and any chronic systemic illness.

Physical examination

General examination

Abdominal and Pelvic – mass or tenderness

Local examination-

1. Vulval / Genital inspection 
2. Speculum Examination – vagina, cervix, tenderness, any other pathology
3. Per veginal examination 

Investigations

1. Discharge – wet film for nay microorganism, KOH test for fungus, gram staining.
2. Pap smear – for any cancerous changes
3. Urine – for culture and sensitivity and Routine Examination
4. Blood test for PID
5. HIV serology 

Homoeopathic approach for vaginal discharge

Philosophical background – of Vaginal discharge

In Organon of medicine practical part is given from aph 71 to 291. In aph 72-82 there is classification of disease by our master. Leucorrhoea falls in which type of disease…..does it is acute?? In etiology, we saw it is due to chronic inflammation or endocrinal dysfunction (estrogen excess) and it remain for long time if not manage properly so obviously it falls in chronic miasmatic disease. 

Key Guidelines for case taking for chronic disease is given in aphorism 94 and 95 which deals about investigation of particular / accessory circumstances and lesser accessory symptoms respectively. Apart from this, In aph. 206- 209 he also wrote about chronic disease treatment you must know the miasmatic background of person and in aph. 208 he explains the importance of understanding mind, disposition and environment of sick in order to cure him.

So according to literature best treatment for chronic disease (vaginal discharge/ long standing leucorrhoea) is constitutional approach Or you can prescribe indicated phasic medicine followed by constitutional remedy.

 Miasmatic cleavage of Leucorrhoea and abnormal excessive vaginal discharge

1. Psoric leucorrhoea – there will be functional changes to the parts either cervix or vagina and patient can have many deficiencies eg. Anaemic with various abnormal sensations. Complaints remains on and off initially and discharges are whitish, Albuminous, odorless and usually bland. At general level patient show a kind of hypersensitivity and good reactivity. This occur due to nervous or endocrinal cause with suddenness of complaints fast progressive functional pathology.
2. Sycotic leucorrhoea/abnormal discharge – this can develop after Psoric state where hypertrophied glandular cells (structural changes) found and with non suppurative chronic inflammation of cervix or vagina. Many times cause of disease you will found holded emotions, suppression of discharges or eruptions. Onset and progress will be slow tissue is functionally poor but structurally shows anabolic properties. Discharges will be thick, greenish-yellow or dark, like dirty water and usually acrid, and excoriating, Indelible and producing pruritus of the parts passed over. Odor is pungent, sour or fish-brine or stale fish. At general level, patient shows a kind of inertia with autoimmune disorder of Sycotic dominancy mentally patient shows dullness of perception, slow registration and poor memory.
3. The tubercular leucorrhoea – patient shows catabolic activity with debility or weakness even after ravenous hunger. Another characteristic is hyperactivity with tardy improvement from chronic suppurative inflammation. You will get fibrosis, scar and local loss of tissue with rapid deterioration. Pseudo-Psora is purulent, thin, or thick, yellowish, with weakness. Diathesis develops that approaches malignancy.
4. In syphilitic leucorrhoea this is condition where localize pathology involves distant vital organs with rapid deterioration of general health. Terminal state of STD and Carcinomatous will come under this class.

Most similimum medicine should be selected on following points. 

1. Disposition make-up
2. physical constitution
3. Mental / physical expression (conscious and sub conscious mind expressions)
4. Diathesis
5. Diseases state – tissue affinity- glands, pathological state and characteristic onset progress and concomitants, and individualizing symptomatology.
6. Miasmatic diagnosis

All above points are included in susceptibility of person on which medicine similarity depends.

Use of Kent’s Repertory

Dr J.T.Kent (31^st March 1849-6^th June 1916) started working with Dr. E.J. Lee who had completed chapter Mind, Head, and Vertigo. Initially book published part by part, in 12 fascicles from 1897-1898 and in 1899 in book form. This is based on deductive logic with 3 typography –  Bold italics and roman. Leucorrhea found in female genitalia section has total 143 medicines and 51 sub-rubrics which are related to following format. Complaints (question formulation) should evaluate on following pattern. Remedies given in Kent repertory according to their Grades are-

Age – Little girls in

Character of discharge – 

1. Nature – Acrid (corrosive/excoriating)

2. Bland, Burning

3. Consistency – 

Albuminous

 Thick

Thin-Watery

Jelly like

Starch boiled like

 Transparent

Ropy, stringy, tenacious

4. Color – 

Bloody

Brown

Green

Milky

Yellow

Black

Bluish

Cream like

White

Gray

Flesh colored

5. Odor – offensive

6. Purulent or non purulent – Purulent

7. Copious or scanty – Copious

Modalities –

1. Causative – 

Coition after

Masturbation from

Sexual excitement from

2. Time – 

Morning

Day time

Afternoon

Evening

Night

3. Aggravation by –

Exercise while

Lying while

Menses relation

Pregnancy during

Sexual

Sitting while

Standing from

Stool after

Walking

Associated with – 

Scanty menses with

Alternate with mental state,

Alternate with cough,

Clinical condition – Gonorrheal

References –

1. Principal And Practice Of Homoeopathy By Dr. M.L. Dhawale
2. ICR Symposium Volume On Hahnemannian Totality: Miasm
3. Organon Of Medicine Edition 6^th 
4. Repertory Of Homoeopathic Material Medica By Dr. J.T. Kent
5. Textbook Of Gynaecology 6^th Edition By D C Dutta
6. Shaw’s Textbook Of Gynaecology 16^th Edition By VG Padubidri And SN Daftary

Dr Saurabh Kumar Sobhari
B.H.M.S., M.D. (Practice of Medicine)
Assistant Professor Practice of Medicine
Naiminath Homoeopathic Medical College Agra