Polycystic ovarian disease- repertorial approach

Dr Ananthakrishnan V A 

In this article we discuss about PCOD and it’s rubrics from various repertories. Hope this article will be helpful for all the physicians to brush up their idea about  PCOD, therapeutics and it’s repertorial aspects.        

SYNONYMS :  Stein-Leventhal Syndrome, Solcrocystic ovarian disease, Polycystic ovaries

Polycystic ovary disease is an endocrine disorder,  which means normal hormone cycles are interrupted. An estimated five to 10 percent of women of childbearing age have PCOS. Hormones direct many functions throughout the body. For example, hormones regulate reproductive functions, including the normal development of eggs in the ovaries. It is not completely understood why or how hormone cycles are interrupted, although there are several working theories.

SYMPTOMS OF PCOD :

The most common symptoms of PCOD are

• Irregular and infrequent menstrual periods or no menstrual periods at all;
• Infrequent or no ovulation with increased serum levels of male hormones – testosterone;
• Inability to get pregnant within one year of unprotected sexual intercourse;
• Weight gain or obesity;
• Diabetes, over-production of insulin with abnormal lipid levels and high blood pressure;
• Excess growth of hair on the face, chest, stomach in male pattern (hirsutism) and male-pattern baldness or thinning of hair; Acne, oily skin or dandruff;
• Patches of thickened and dark brown or black skin on the neck, groin, underarms, or skin folds;
• Skin tags, or tiny excess flaps of skin in the armpits or neck area;
• Male fat storage patterns – abdominal storage rather than standard female pattern on thighs, hips and waist; and Mid-cycle pain indicating painful ovulation – due to the enlargement and blockage of the surface of the ovaries;

Other rare symptoms
Tiredness, weakness, lack of energy, excessive craving for sweets and chocolates, irritability and emotional liability, have also been reported in patients with PCOD. Some of these symptoms may be due to insulin resistance.

Asymptomatic
20% of women with polycystic ovaries may be asymptomatic and some of these women may be diagnosed to have polycystic ovaries an ultrasound scan performed to exclude any other gynecological pathology. A future gain in weight can also make these patients develop all other features of PCOD.

SIGNS OF PCOD 

• Multiple cysts on the ovaries, sonography they may present as a “string of pearls”.
• Enlarged ovaries, generally 1.5 to 3 times larger than normal resulting from multiple cysts.
• Thickened smooth pearl white outer surface of ovary.
• Chronic pelvic pain, possibly due to pelvic crowding from enlarged ovaries.
• The ratio of LH to FSH is 2:1 or more, particularly in the early phase of menstrual cycle.
• Increased level of testosterone.
• Decreased level of sex hormone binding globulin.
• Hyperinsulinemia.

RUBRICS RELATED TO PCOD WITH REMEDIES FROM DIFFERENT REPERTORIES

Kent :

FEMALE GENITALIA – MENSES, – absent,amenorrhoea
Acon. aesc. agar. agn. alet. Am-c. am-m. Ant-c. Apis Apoc. arg-n. Ars. Ars-i. AUR. Bar-c. Bell. benz-ac. berb. Borx. Bry. Calc. calc-s. canth. CARBN-S. carb-v. card-m. Caul. Caust. Cham. chel. Chin. chinin-ar. cic. cimic. cina Cocc. colch. Coll. Coloc. CON. croc. crot-t. Cupr. Cycl. dig. Dros. DULC. euph. FERR. Ferr-ar. FERR-I. Ferr-p. gels. Goss. GRAPH. Guaj. Ham. Hell. helon. Hyos. Ign. Iod. Kali-ar. KALI-C. kali-i. Kali-n. Kali-p. kali-s. Lach. lil-t. lob. LYC. Mag-c. Mag-m. Merc. mill. nat-c. Nat-m. nat-p. Nux-m. Nux-v. ph-ac. Phos. Plat. podo. PULS. Rhus-t. Sabad. sabin. sang. sec. SENEC. SEP. SIL. Staph. stram. SULPH. TUB. Valer. verat. verat-v. xan. Zinc.

GENERALS – OBESITY
agar. ambr. Am-m. Ant-c. asaf. Aur. bar-c. borx. bry. CALC. Calc-ar. camph. canth. CAPS. chin. cocc. con. Cupr. euph. FERR. GRAPH. guaj. iod. ip. Kali-bi. Kali-c. Lac-d. lach. laur. Lyc. mag-c. merc. mur-ac. nat-c. nux-m. olnd. op. plat. plb. Puls. sabad. sars. seneg. sep. sil. spig. spong. Sulph. thuj. verat.

SKIN – DISCOLORATION, – blackish
acon. ant-c. Apis Arg-n. ARS. asaf. aur. Carb-v. chel. Crot-h. Lach. nit-ac. ph-ac. phyt. PLB. SEC. spig.

Synthesis:
FEMALE GENITALIA/SEX – MENSES – absent
Acon. aesc. agar. agn. alet. all-c. aln. Am-c. am-m. ammc. Anac. Ant-c. Apis Apoc. arg-n. Arist-cl. Ars. Ars-i. asar. asar-c. AUR. aur-ar. aur-i. aur-s. aven. Bar-c. Bell. bell-p. benz-ac. berb. Borx. brass-n-o. brom. Bry. Calc. calc-i. calc-o-t. calc-p. calc-s. calc-sil. cann-s. canth. carb-v. CARBN-S. card-m. Caul. Caust. Cham. chel. Chin. chinin-ar. chlorpr. cic. cimic. cina Coca Cocc. Coch. colch. Coll. Coloc. CON. cortico. cortiso. croc. crot-t. Cupr. Cupr-act. Cycl. Cypr. dam. dig. dream-p. Dros. DULC. euphr. eupi. FERR. Ferr-ar. FERR-I. ferr-m. Ferr-p. ferr-r. gast. gels. Glon. goss. GRAPH. Guaj. Ham. hedeo. Hell. helo. helon. hoit. Hyos. hyper. ictod. Ign. indg. Iod. joan. Kali-ar. KALI-C. kali-i. Kali-n. Kali-p. Kali-perm. kali-s. kreos. lac-d. lac-f. Lach. lil-t. linu-c. lob. luf-op. LYC. m-arct. Mag-c. Mag-m. mag-s. mand. mang. med. Merc. Merl. mill. Mit. nat-c. Nat-m. nat-p. nat-sil. nep. Nux-m. Nux-v. ol-an. Ol-j. op. orot-ac. ovi-p. parth. ph-ac. Phos. Phyt. pin-l. pitu. Plat. plb. podo. polyg-pe. polyg-xyz. polytr-c. PULS. puls-n. rhod. Rhus-t. rub-t. Sabad. sabin. sang. sanic. sec. SENEC. SEP. sieg. SIL. Sin-n. spong. Staph. stram. sul-i. SULPH. syc. symph. tanac. tep. ther. thiop. Thuj. thyr. TUB. urt-u. ust. Valer. verat. verat-v. vib. wies. wye. x-ray xan. yohim. Zinc. zinc-p.

SKIN – HAIR – Unusual parts; on carc. lyc. med. thuj. thyr.

SKIN – DISCOLORATION – blackish =acon. ant-c. Apis Arg-n. arn. ARS. asaf. aur. Carb-v. chel. Crot-h. lac-e. Lach. nit-ac. ph-ac. phyt. PLB. SEC. sol-t-ae. spig.

BOGER :

GENERALITIES – Obesity – am-c. Ant-c. bell. bufo-s. CALC. Caps. ferr. graph. kali-bi. phyt. puls. sulph.

Murphy :Female – AMENORRHEA, menses, absent
Acon. aesc. agar. agn. alet. all-c. aln. Am-c. am-m. ammc. Anac. Ant-c. Apis Apoc. arg-n. Arist-cl. Ars. Ars-i. asar. AUR. aur-i. aven. Bar-c. Bell. bell-p. benz-ac. berb. Borx. brom. Bry. Calc. calc-i. calc-p. calc-s. calc-sil. cann-s. canth. carb-v. CARBN-S. card-m. Caul. Caust. Cham. chel. Chin. chinin-ar. chlorpr. cic. Cimic. cina Coca Cocc. Coch. colch. Coll. Coloc. CON. cortico. cortiso. croc. crot-t. Cupr. Cycl. Cypr. dam. dig. Dros. DULC. euph. eupi. FERR. Ferr-ar. FERR-I. Ferr-m. Ferr-p. gast. gels. Glon. Goss. GRAPH. Guaj. Ham. hedeo. Hell. Helon. Hyos. hyper. ictod. IGN. indgh. PULS. Rhus-t. Sabad. sabin. sang. sanic. sec. SENEC. SEP. sieg. SIL. Sin-n. spong. Staph. stram. sul-i. SULPH. symph. tanac. tep. thiop. Thuj. thyr. TUB. urt-u. ust. Valer. verat. verat-v. Vib. wies. Iod. Kali-ar. KALI-C. kali-i. Kali-n. Kali-p. Kali-perm. kali-s. kreos. lac-d. Lach. lil-t. linu-c. lob. LYC. Mag-c. Mag-m. mag-s. mand. mang. Merc. Merl. mill. Mit. nat-c. Nat-m. nat-p. nat-s. nat-sil. nep. Nux-m. Nux-v. ol-an. Ol-j. op. ovi-p. parth. ph-ac. Phos. Phyt. pin-l. pituin. Plat. plb. podo. Polyg-. wye. x-ray xan. Zinc. zinc-p.

Female – AMENORRHEA, menses, absent – girls, in young Ign. x-ray

Female – AMENORRHEA, menses, absent – women, in Ars. bar-c. Calc. cypr. Ign. petros. psor. Puls. SEP. sil. sulph.

Constitutions – YOUNG, constitutions Acon. Calc. Calc-p. ferr. gels. IGN. NAT-M. PHOS. SIL.

Generals – OBESITY, general – uterine, complaints, with calc. Graph. Kali-c. Sep.

Generals – OBESITY, general – young, people, in Ant-c. CALC. calc-act. lach.

Skin – HAIR, skin – unusual, parts, on carc. lyc. med. ol-j. thuj. thyr. tub.

Skin – HAIRY, skin – women, in carc. cortico. Sep.

Skin – BLACKISH, discoloration, skin
acon. aeth. anac. ant-c. Apis Arg-n. ARS. asaf. aur. both. Carb-v. chel. cic. Crot-h. ferr. Lach. Led. nit-ac. ph-ac. phos. phyt. PLB. rhus-t. sabin. sars. SEC. sol-ni. spig. vip.

PHATAK :

M – Menses – absent, suppressed, amenorrhoea
aur. bell. cimic. Con. cupr. cycl. Dulc. Graph. hell. helon. Kali-c. lac-d. lach. Lyc. nat-s. phos. PULS. Senec. sep. Sil. Sulph. tub. xan.

M – Menses – absent, suppressed, amenorrhoea – girls, young senec.

BOERICKE :

O – Obesity
am-m. Ant-c. bell. bufo CALC. CAPS. Ferr. Graph. kali-bi. lac-d. lith-c. phyt. puls. rumx. seneg. sulph. thyr.

H – Hair – chin and upper lip in women; on ol-j

FEMALE SEXUAL SYSTEM – Menstruation – type – Amenorrhoea
Acon. alet. aln. Apis apoc. ars. aven. bell. bry. Calc. cann-s. Caul. caust. Cimic. con. Cycl. dulc. Euphr. Ferr. Ferr-ar. Ferr-r. gels. Glon. Graph. hedeo. Hell. Helon. joan. Kali-c. Kali-perm. lil-t. mang-act. Merl. Nat-m. nux-v. op. parth. ph-ac. pin-l. Plat. plb. Polyg-h. Puls. sec. Seneg. Sep. spong. Sulph. tanac. thyr. ust. Xan.

DIRECT RUBRICS FROM DIFFERENT REPERTORIES

1. Boericke’s Repertory 

Chapter: – Female Sexual System

Rubric: – Ovaries: Pain: In left ovary

3marks: Arg-met, Cimic, Coll, Lach, Lil-tig, Naja, Thuja, Vesp, Xanth, Zinc.

2marks: Am-br, Ap-g, Apis, Caps, Carb-ac, Erig, Eup-pur, Frax, Graph,

Iod, Med, Murx, Ov, Phos, Pic-ac, Thea, Thlaspi, Ust, Wye

2. Clarke’s Clinical Repertory 

Chapter: – Clinical

Rubric: – Cyst:

2marks: Bar-c, Bov, Calc-s, Staph.

3. Complete Repertory 

Chapter: – Female Genitalia

Rubric: – Pain: Stitching: Left,through uterus to right ovary:

1mark: Lac-can, Phos, Thuj.

4. Gentry’s Concordance Repertory 

Chapter: – Uterus & Appendages

Rubric: – (a) Cyst: Region of left ovary in:

1mark: Murx.

(b) Left: Ovaritis of left ovary:

1mark: Arg-met, Caps, Graph, Lach, Podo, Thuj, Zinc.

5. Lippe’s Repertory 

Chapter:- Female Sexual Organs

Rubric:- Darting pains from left labia through uterus to right ovary

1mark: Bell, Lac-can, Phos, Thuj.

6. Synthesis/Kent’s Repertory 

chapter:- Female Genitalia/Sex

Rubric:- Tumours-ovaries: cysts:

2marks: Apis, Bov, Bufo, Coloc, Iod, Kali-br, Lach, Plat, Rhus-t.

1mark: Arg-m, Canth, Carb-an, Merc, Murx, Prun, Rhod, Syph, Thuj.

THERAPEUTICS 

ARGENTUM METALLICUM :

• Pain in left ovary.
• Ovaries feel too large.
• Prolapsus uteri, with pain in left ovary and small of the back, extending in front and downwards.
• Eroded spongy cervix.
• Scirrhus of uterus.
• Climacteric haemorrhage.
• Leucorrhoea; foul, bloody water, excoriating.
• Ovarian cysts, tumours.
• Palpitation during pregnancy.

LILIUM TIG :

• It manifests its chief action upon the VENOUS CIRCULATION; of the heart and FEMALE ORGANS; ovaries and uterus; and is useful for many relfex conditions dependent on some pathological condition of these organs.
• Often indicated in unmarried women.
• FULL, HEAVY or FORCED OUT feeling; in uterus, ovaries, heart etc.
• Utero-ovarian sagging.
• Wandering, flying,shooting pains or opening and shutting pains; radiating; from ovary to heart, to left breast; down the legs etc.
• Heavy dragging or outward pressing in pelvis, with dysuria; as if all organs would escape through vagina; must hold it.
• Menses; early, scanty, dark, clotted, offensive.
• Flow only when moving about.
• Ovarian (left) pain down thighs; or up below the left breast.
• Leucorrhoea; thin, brown, acrid; stains brown, agg. after menses.
• Neuralgic pains in uterus, can not bear pressure of clothes.
• Prolapse of anteversion of uterus.
• Sul-involution.
• Sexual desire increased; obscene; must keep herself busy.
• As of a rivet or ball under (left) mamma.
• As of a hard body pressing upon rectum and ovaries amel. walking.

MUREX :

• Pain stitching in genital; up through abdomen; into the breasts.
• Painfully sore uterus; consciousness of womb.
• Feeling as if something was pressing on a sore spot in the pelvis amel. sitting.
• Violent nervous sexual desire; nymphomania; from least contact with the parts.
• Bearing down pains; must keep legs tightly crossed.
• Copious menses with large clots.
• Leucorrhoea; thick; yellow bloody; alternating with mental symptoms.
• Pain in mammae during menses.
• Walking difficult, all joints are weak during pregnancy.
• Prolapse, enlargement of the uterus.
• Discharge of blood through the vagina or bloody leucorrhoea, during stools.
• As if bones of pelvis getting loose.

MEDORRHINUM:

• Sycotic taint. 
• A/F suppressed gonorrhea or inheritant gonorrhea for women with chronic pelvic disorders. -When the best-selected remedy fails to relieve or permanently improve. 
• Remedy for fibroids, cysts and other morbid growths of uterus and ovaries. 
• Chronicity, obstinacy of complaints. 
• A great deal of pain in left ovary, with a sensation as if a sac was distended and if pressed would burst, sensation as if something was pulling it down, causing it to be sore, pain when walking passed to left groin.
• Tense pains passing diagonally in right ovary, followed by a bubbling sensation.

MERCURIUS SOLUBILIS:
Good for ovarian affections, inflammation of ovaries and uterus

NAJA:

• Remedy for affections of ovary. 
• Crampy pain in left ovary. 
• Aching in left ovary with pains in heart, come on a week before menses; grow worse till menses appear, then easier till next month

OOPHORINUM:

• It has been suggested as a remedy in ovarian cysts. 
• Suffering following excision of ovaries.

PRUNUS SPINOSA:
Tickling, itching in region of ovaries not ameliorated by scratching and rubbing.   Menstruation too early, with violent pain in small of back. Metrorrhagia of thin,  pale blood, becoming very watery the longer it lasts.

APIS:

• It has been used for pains occurring in the right ovarian region and thought of being due to ovarian disease.
• Amenorrhoea of puberty, ovaries; numb or congested due to suppressed menses.        Dysmenorrhoea with scanty discharge of slimy blood or with ovarian pains.
• Ovarian dropsy, even cystic degeneration of the ovary has been cured. 
• Ovarian neuralgia, ovarian and uterine inflammations may call for this drug.
• The right ovary is mostly affected.
• Burning stinging pains and great soreness in right ovarian region are the most characteristic symptoms.

CONCLUSION
For effective management of PCOD, the repertory will act as the key towards the remedy. The important point to be remembered is that the selection of repertory. It must be selected according to the principles explained by our poineers. This depends on the subjective as well as objective symptoms we acquire. So according to the data which we get we analyze them and select the totality as well as repertory. If the method which we adopt is right, then we ends up in exact similimum. Even after repertorisation don’t forget to go through the materia medica and confirm the Medicine.

BIBLIOGRAPHY

• SHAW’S TEXT BOOK OF GYNAECOLOGY
• TEXT BOOK OF GYNAECOLOGY by D.C.DUTTA
• RADAR REPERTORY PROGRAMME
• KENT’S REPERTORY OF HOMOEOPATHIC MATERIA MEDICA
• BOGERS REPERTORY
• MURPHY’S REPERTORY
• PHATAK REPERTORY
• BOERICKE’S REPERTORY
• CLARKE’S CLINICAL REPERTORY
• GENRY’S CONCORDANCE REPERTORY
• COMPLETE REPERTORY
• LIPPE’S REPERTORY
• SYNTHESIS REPERTORY

Dr Ananthakrishnan V A
PGT
Father Muller Homoeopathic Medical College Mangalore