Treating hyperuricemia with homoeopathic medicines

Dr Lakshmipriya B Menon

ABSTRACT
Hyperuricemia is defined as an abnormal elevation of serum uric acid more than 6mg/dl, associated with obesity, alcoholism and other metabolic disorders like diabetes mellitus, hypertension, dyslipidemia and gout. Gout is presented with symptomatic hyperuricemia¹.Hyperuricemia is more common in obese people compared with others. In developing countries, the ratio of prevalence of hyperuricemia in males is more compared with females,5:1². About 25.8% peoples were affected in India according to a recent studies³.

KEYWORDS
Hyperuricemia, Homoeopathy, Pathological general rubric, Uric acid diathesis, Murphy Repertory, Pareira Brava.

INTRODUCTION
Serum uric acid was first noted in 1870’s which is associated with increased BP by Fredrick Mohammed. Recent studies shows that the increase in uric acid is risk factor for hypertension and cardiovascular diseases. It will be initially reversible but later it becomes irreversible⁴.

Hyperuricemia is the earliest stage of gout, which is the most common cause for inflammatory arthritis in men over 40 yrs. and women in over 60 yrs. According to the text book of medicine by Dr Krishnadas “The normal plasma level of uric acid varies from 2-7mg/dl in a healthy person. The term Hyperuricemia denotes value above 7 mg/dl in men and 6mg/dl in women” ⁶.

As from the observation of Henri Huchard, a French academician, those having gout, lead poisoning and a diet enriched with fatty meat are associated with hyperuricemia. Both in animal and human studies are strongly indicating uric acid as a factor in the onset of essential hypertension, and it can leads to progression of renal injury³. There is an inverse association between increase uric acid and fasting blood glucose may be related to the inhibition of uric acid reabsorption in the PCT by high glucose level in diabetic patients⁴.

Increased uric acid production can impaired renal uric acid excretion or a combination of both lead to hyperuricemia. The daily excretion of uric acid is 500 – 700mg. At physiological pH, uric acid is mainly ionized and present in plasma as sodium urate.

Hyperuricemia is to be often associated with high living, over eating and alcohol consumption. In the past centuries, alcohol was contaminated with lead during the

manufacturing and its storage and lead poisoning leads to the kidney damage and decreased uric acid excretion⁵.

The major clinical manifestation includes synovitis, tophi, arthritis, nephrolithiasis and interstitial nephritis. The excessive amount of MSU crystals can be due to over intake of purine rich food or it can be due to inability to excrete the excessive uric acid.

Its complication can be characterized by urate in kidney, renal failure, hypertension and heart failure. Excess amount of uric acid can cause into solid crystals. These crystals of uric acid can accumulate in joints and nearby tissues, it will be sharp and needle like urate crystals which will be hard lumpy deposits in joints with inflammation called tophi and it results in painful attacks called gout^7,8,9.

Recent studies in human found that increased uric acid levels can cause or predicts the development of hyper insulinemia¹⁰, obesity¹¹, type 2 diabetes and it also common in the metabolic syndrome. However, studies to test the effect of reducing the level of uric acid on features of metabolic syndrome in humans have yet to perform¹².

There is association between hyperuricemia and metabolic syndrome, constellation of insulin resistance, hypertension, obesity and dyslipidemia and gouty patients have a medical history of kidney disease, diabetes mellitus and vascular illness like coronary artery diseases, heart failure and stroke which results poor quality of life¹³.

Miasms dispose the body towards a certain diathesis like, the patient develops with hyperuricemia due to their lithaemic diathesis. Due to this constitutional dyscrasia patient develops tendency to accumulation of uric acid crystals in his body.

Uric acid diathesis is also known as lithaemic, rheumatic or gouty diathesis and the constitutional disease with sycotic manifestations comes under hydrogenoid diathesis of VON-GRAUVOGL¹⁴.

Rubric related to uric acid diathesis and Hyperuricemia in Homoeopathic Medical Repertory:

Chapter –Clinical

URIC ACID, diathesis-

• 4 Marks: COLCH
• 3 Marks: BENZ-AC, PAREIR, PULS, UR -AC, URT-U
• 2 Marks: apis, bar -m, calc-p, canth, caps, carbn-s, cham, crot-h, epig, lyc, mag-c, meny, oci, urea

HOMOEOPATHIC MANAGEMENT

Urtica urens
Rheumatism of arm, when deltoid muscles are affected.
Pain in right deltoid muscle with cramp like pain < in evening (pm, stiff soreness on inside of left knee – rheumatic pain in both ankle)
Rheumatic stiffness and pain in right wrist, later rheumatic pain in left arm, wrist and fingers – raised, red, itching blisters on the skin of hands and fingers.

Colchicum Autumnale

• Adapted to rheumatic gouty diathesis.
• Pain of rheumatism move from one joint to another and are especially worse motion and are better by cold even though one is cold, worse cold damp weather.
• Lower limb often grows so weak the knees knock together. Big toe inflamed; sharp sticking pains worse by touch.

Ocimum canum

• Severe colicky pain with violent vomiting, person twists about in agony, screams and moans.
• Right sided renal calculi with violent vomiting
• Red urine with brick red sediment after attack.
• Renal colic with numbness of the right thigh.
• Pain and swelling in right ankle joint < morning.

Benzoic Acid

• A gouty rheumatic diathesis engrafted on a gonorrhoel or syphilitic patient.
• Pain tearing, stitching in large joints of big toe with redness and swelling of joints <night.
• Pain suddenly changes their locality with urine and stool has very offensive strongly pungent odour, usually dark urine but light urine may alternate with heavy urine.

Ledum Palustre

• Adapted to rheumatic gouty diathesis, constitutions abused by alcohol.
• Rheumatism begins in the lower limbs and ascends, especially if brought to low asthenic condition by abuse of colchicum.
• Obstinate swelling of feet. Soles of feet are painful when walking as if they were filled with blood.heat in the hands and feet in the evening, long continued warm sweat on the hands and feet, numbness and gone to sleep feeling of the limbs.

Pulsatilla

• Joints chiefly affected are the ankles and small joints of hands and feet.
• Swelling of knee and ankle joint as well as the small joints of the fingers and toes together with the drawing and tensive pain in them.
• Simple pain in the limbs and joints, obliging him to stretch the body with heat of the whole body, thirst in the morning in the bed.

Kali carbonicum

• Backache, weakness and perspiration – charecteristics.
• Arthritis, deformitive arthritis, worse in small joints, nightly rheumatic pains. Sharp, aching pain in the joints and tendons. Spasmodic contraction of fingers and toes. Knees painful,<going upstairs or downstairs.

Lycopodium

• Drawing and tearing pain in limbs especially at rest or at night. Tearing in shoulder and elbow joints, chronic gout. Finger joints are distorted and filled with chalk deposits. Pain in the heels on treading, as if from a pebble. Hands and feet numb. Cracking of joints when stretched.
• Pain in left kidney and ureter. Turbid milky urine with offensive purulent sediment, dull pressing pain in the region of bladder and abdomen. Produces lithic acid deposit in quantities, hence pain in kidneys and bladder.

Berberis Vulgaris

• Suited to elderly gouty people who are pale, sickly and chilly with twinges in the finger joints where deposits are usually painful, numbness and stiffness with painful pressure in renal and lumbar regions.
• Gouty concretions in the auricles that become very painful with pain that tears and sting which worse with deep pressure, extend down the back and into the pelvis along the course of the uterus, wander from joints to joints, back feels stiff and numb.

Bryonia Alba

• Knee stiff and painful, joints red, swollen, hot with stitches and tearing, worse on least motion.
• Painful stiffness in the nape of neck. Stitches and stiffness of lumbar region.
• From sudden change of weather.
• Pain in joints and limbs better by warmth.
• Hot swelling of feet, ankle or knee injury, swollen painful and worse motion.

REFERENCES

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Dr Lakshmipriya.B.Menon , BHMS ,
MD Repertory Scholar Father muller homoeopathic medical college, Mangalore
Under the Guidance by Dr Rita Chakraborty
HOD, Department of Repertory