Dr Jyoti Chhikara, MD Scholar, Department of Homoeopathic Materia Medica, Bakson Homoeopathic Medical College and Hospital, Greater Noida, UP.
Dr Priya Garg, MD Scholar, Department of Homoeopathic Materia Medica, Bakson Homoeopathic Medical College and Hospital, Greater Noida, UP.
Diarrhea is a very frequently encountered condition, usually mild and brief, but sometimes can be severe in childhood and old age. A person is said to have diarrhoea if there are more bowel movements than usual and if the stools are less formed and more watery than usual. During an episode of severe diarrhoea, one can become dehydrated and exhausted very quickly due to excessive loss of body fluids.
The symptoms that may accompany diarrhoea which include fever, loss of appetite, nausea, vomiting, stomach pains, cramps, blood and/or mucous in the bowel movement, dehydration, lethargy, exhaustion can often be treated with the acid group of remedies, debility being a marked characteristic in this group. Weakness and profound prostration are guiding symptoms which often form the basis of prescription of acids, are usually encountered as symptoms in cases of diarrhoea. Also as per norms, a good history, physical examination (looking for signs of anemia, pallor, icterus, edema, dehydration etc.) and understanding of the etiologic pattern of diarrhea together with an individualized approach should be a forerunner to investigative the workup for the cases of diarrhoea as well.
Characteristics of the Acid group:
- Constitution-Thin, weak, broken down; pale, anaemic; debilitated, prostrated with stooped shoulder and premature old look.
- Miasmatic background– Predominant syphilitic but all the three miasms in general.
- Diathesis- Haemorrhagic tendency, bleeding disorders and destruction of blood.
- Thermally– Chilly except Fluoric acid and Picric acid which are hot.
- Sphere of action- Mind, CNS, mucous membranes, skin, muco-cutaneous junctions, glands, sexual organs, secretions etc.
- Ailment from– Debaucheries, grief, worries, chagrin, mortification, sleeplessness, stimulants, injury, insect bite etc.
- Side– All acids have predominant action on both sides. Although a major number have action on right side.
- Depth of action– All acids are very deep acting. Mineral acids are deeper acting than organic acids. Eg; Cancerous states (Nit-ac, Fl-ac), Ulcer & cancerous condition of the intestine (Mur-ac), Tetanus like condition (Hydr-ac), Multiple sclerosis (Ox-ac), paralytic conditions (Pic-ac), Depressive psychosis (Ph-ac), Varicose ulcers or veins (Fl-ac).
- Discharges – Acrid, excoriating, burning, putrid, offensive & haemorrhagic and sour smelling.
- Tendencies- To cracks, fissures, fistulas and pseudo-membrane formation
- Pains – Pricking, stitching, splinter like.
- Modalities– <night, cold, daft of air, touch, exertion (mental and physical), stimulants, loss of sleep; >warmth, short sleep, rest.
- There are total 88 acid remedies mentioned under various Materia Medica literature from which the rubric “Rectum- Diarrhoea- general” covers 20 acids [Complete repertory] (1) :
(4+) Acet-ac, Benz-ac, Carb-ac, Fl-ac, Mur-ac, Nit-ac, Ox-ac, Ph-ac, Sul-ac
(3+) Cit-ac, Hip-ac, Hydr-ac, Pic-ac, Sal-ac
(2+) Chr-ac
(1+) But-ac, Chrys-ac, Oro-ac, Lac-ac, Tann-ac
Diarrhoea and its associated complaints can be dealt with homoeopathy in both acute as well as chronic presentation. Many acid remedies are indicated in diarrhoea in various life stages and constitutions, for various etiological and modifying considerations such as weather, affections of mind, accompanying symptoms, food dyscrasias, periodicity, time etc. and their association with pain and debility/weakness, and hence can be selected on the basis of symptom similarity and used as prophylaxis as well.
Table 1 Indications of acids for diarrhoea in various life stages and/or constitutions (1)
| LIFE STAGE/
CONSTITUITON |
children, in: acet-ac. (1), BENZ-AC. (3), MUR-AC. (3), nit-ac. (1), PH-AC.(3), sul-ac. (1) | |
| children, in – rachitic: ph-ac.(1) | ||
| dentition, during: acet-ac.(1), benz-ac. (1), NIT-AC.(3), ph-ac. (1), sul-ac. (1) | ||
| emaciated people, in: SUL-AC. (3) | ||
| gouty subjects: benz-ac.(1) | ||
| old people, in: FL-AC.(3), NIT-AC.(4) | ||
| old people, in – prematurely, with syphilitic mercurial dyscrasia: FL-AC.(3) | ||
| old people, in – weakness, with great: NIT-AC.(4) | ||
| pregnancy, during: mur-ac.(1), ph-ac.(1), sul-ac.(1) | ||
| thin persons, in: sul-ac.(1) |
Table 2 Indications of acids for diarrhoea with accompanying symptoms (1)
| FEVER | fever – with: carb-ac.(1), mur-ac.(1), nit-ac.(1), ph-ac.(1), sul-ac.(1) | |
| fever – with – delivery, parturition, after, puerperal: carb-ac.(1) | ||
| fever – with – typhoid: MUR-AC.(3), NIT-AC.(3), PH-AC.(3), SUL-AC.(3) | ||
| PAIN | painful: nit-ac.(1) | |
| painless: nit-ac.(1), PH-AC.(4), SUL-AC.(3) | ||
| painless – night: ph-ac. (1) | ||
| painless – night – chill, during: ph-ac.(1) | ||
| WEAKNESS | Weakness-stool-after-diarrhea : NIT-AC.(4), PH-AC.(3), ACET-AC.(3), SUL-AC.(3), PIC-AC.(4), mur-ac.(1), TART-AC.(3), ox-ac.(1), sal-ac.(1) | |
| Weakness-stool-after-diarrhea-suppressed: ph-ac.(1) | ||
| Weakness- during: NIT-AC.(4),FL-AC.(3) | ||
| Weakness- after-diarrhea-tuberculosis, in: NIT-AC.(3) | ||
| Collapse- diarrhea, after : hydr-ac.(1) | ||
| Collapse- discharges, after suppressed: hydr-ac.(1) | ||
| Faintness, after : gall-ac.(1) | ||
| weakness – without: PH-AC(4) | ||
| OTHER ACCOMAPNYINGCONDITIONS | general – coryza – during: nit-ac.(1) | |
| dropsy, in: acet-ac.(1) | ||
| hydrocephalus, during acute: CARB-AC.(3) | ||
| tuberculosis, during: acet-ac. (1),nit-ac.(1), PH-AC.(3) | ||
| typhoid fever, from: MUR-AC.(3) ph-ac.(1) | ||
| loss of fluids, after: ph-ac(1) | ||
| menses – during: ph-ac. (1), sul-ac.(1) | ||
| septic conditions, from: CARB-AC. (3) | ||
| bilious: FL-AC. (3),MUR-AC. (3), NIT-AC.(3), PH-AC.(3) | ||
| sleep – agg. – after: pic-ac.(1) |
Table 3 Indication of acids for diarrhoea management based on modifying factors (1)
| TIME OF THE DAY | Morning: acet-ac.(1), FL-AC.(3), MUR-AC. (3), NIT-AC.(1) (early), oro-ac.(1), ox-ac.(1), PH-AC.(3), sul-ac(1) | |
| rising, after: fl-ac.(1), oro-ac.(1), ox-ac.(1) | ||
| Forenoon: mur-ac. (1) | ||
| Evening: benz-ac.(1), carb-ac.(1), fl-ac.(1), MUR-AC(3), nit-ac.(1), PH-AC.(3), PIC-AC.(3), sal-ac.(2), sul-ac.(1) | ||
| Afternoon- BENZ-AC.(3), mur-ac.(1), oro-ac.(1), sulph-ac.(1) | ||
| afternoon – five pm. – seven pm., until: BENZ-AC(3) | ||
| night – agg: fl-ac.(1) PH-AC.(4), SUL-AC.(4) | ||
| midnight – after – four am: fl-ac.(1), mang-act.(1) | ||
| PERIODICITY | Periodic: carb-ac.(1,) Fl-ac.(1,,) Nit-ac. (1) | |
| Every – other day: CARB-AC.(3), Fl-ac. (1), Nit-ac.(1) | ||
| Chronic: acet-ac.(1), NIT-AC.(3), PH-AC.(3) | ||
| Continued: sul-ac.(1) | ||
| WEATHER / TEMPERATURE | winter: NIT-AC.(3) PH-AC.(3) | |
| chill – during: ph-ac. (1) | ||
| cold – becoming, after: PH-AC(3) | ||
| cold – taking, after: nit-ac.(1), PH-AC.(3) | ||
| weather – change of, from: nit-ac.(1), PH-AC.(3) | ||
| weather – cold, from: NIT-AC.(3) | ||
| weather – hot, in: benz-ac.(1) mur-ac.(1), PH-AC.(3), SUL-AC.(3) | ||
| MENTAL CAUSATIONS | anticipation, after: PH-AC.(3) | |
| general – excitement, emotions, from: PH-AC. (3), SUL-AC.(3) | ||
| exhilaration-diarrhea, in(1) : ox-ac(1) | ||
| fear, from: PH-AC(3) | ||
| fright, after: ph-ac. (1) | ||
| grief, after: PH-AC.(3) | ||
| mental exertion, after – agg.: PIC-AC(3) | ||
| prostration of mind- diarrhea-suppressed, from(1) : ph-ac(1) | ||
| irritability-stool-during-diarrhoea(10) : SUL-AC(3) | ||
| school, going to: PH-AC.(3) | ||
| thinking of it: ox-ac.(1) | ||
| FOOD/DRINKS | acids, after: PH-AC. (3) | |
| breakfast – after – agg. :ox-ac.(1) | ||
| antibiotics, after: nit-ac.(1) | ||
| aloe, after abuse of: mur-ac.(1) | ||
| beer – agg.: MUR-AC.(3) | ||
| coffee – after: fl-ac.(1), ox-ac.(1) | ||
| coffee – smell of, after: sul-ac.(1) | ||
| dinner, after: nit-ac(1) | ||
| drinking agg.: fl-ac(1), SUL-AC.(3) | ||
| drinks – agg. – cold: fl-ac. (1), nit-ac.(1), PH-AC. (3), SUL-AC(3) | ||
| drinks – agg. – warm: FL-AC.(3) | ||
| eating – after – agg.: FL-AC. (3), MUR-AC. (3), PH-AC.(3), SUL-AC.(3) | ||
| eating – after – amel.: nit-ac.(1) | ||
| food – cold – agg.: NIT-AC. (3), PH-AC.(3), sul-ac.(1) | ||
| fish, after – salmon: FL-AC.(3) | ||
| fruit, after: MUR-AC.(3), PH-AC.(3), SUL-AC.(3) | ||
| fruit, after – sour: PH-AC.(3) | ||
| fruit, after – unripe: SUL-AC.(3) | ||
| indiscretion in eating, after the slightest: fl-ac.(1), PH-AC.(3), sul-ac.(1) | ||
| lemonade, after: CIT-AC.(3) | ||
| milk – agg.: nit-ac.(1) | ||
| opium, after: MUR-AC.(3) | ||
| oranges, after: PH-AC.(3) | ||
| oysters, after: SUL-AC.(3) | ||
| pastry, after: PH-AC. (3) | ||
| sour food – agg.: PH-AC.(3) | ||
| sugar, after: ox-ac.(1) | ||
| POSITION | lying – agg.: nit-ac.(1), ox-ac.(1), ph-ac.(1) | |
| motion – agg.: mur-ac.(1), ox-ac.(1) |
Now let us have a comparative look at presentation of diarrhoea in each of these acids to better understand how acids can very well manage the prostration, debility and other symptoms associated with cases of diarrhoea.
- ACETIC ACID (ACET-AC)
- Diarrhoea; copious, exhausting, with swelling of legs and feet (phthisis); in later stages of abdominal typhus; chronic with thirst (ascites); <morning; profuse, very weakening (15 passages) on seventeenth day (typhus); with night sweats. Intense, burning, insatiable thirst in chronic diarrhea. Mentally irritable, worried about business affairs.
- BENZOIC ACID (BENZ-AC)
- Stools are watery, light coloured; copious; offensive (in children), with unusually strong-smelling urine; frothy, like soapsuds. Diarrhoea of children; during dentition; white, offensive, exhausting liquid stools, running “right through the diaper”. In afternoon from five pm. until seven pm (Schmidt, Pierre). < Open air; by uncovering.
- BUTYRIC ACID (BUT-AC)
- Stool accompanied by pain and straining with cramps in pit of stomach, < night. Bowels are irregular. Poor appetite. Much gas in stomach and bowels. Stomach feels heavy and overloaded.
- CARBOLIC ACID (CARB-AC)
- Mucous stools like scrapings of mucus membranes, and great tenesmus in diarrhoea and dysentery; stools like rice-water; thin, involuntary, black; very offensive. Cholera infantum, with putrid discharge like foul eggs. Diarrhoea, from septic conditions. Acuteness of smell is a strong guiding symptom. <Physical exertion.
- CHROMICUM ACID (CHR-AC)
- Stools are watery, frequent, and copious, with nausea and vertigo. Symptoms come and go suddenly, and return periodically; offensive discharges.
- CHRYSOPHANICUM ACID (CHRYS-AC)
- Vomiting, followed by stools of a watery character, brown in color, without griping, especially in children. Either vomiting, or purging, of large quantities of bile.
- CITRIC ACID (CIT-AC)
- Pain and cramping in umbilical region ameliorated by passing flatus or after stool. Cutting pain at midnight causing person to bend double. Distention. No urging for stool. Stickiness of stools. Mentally person is dull and forgetful.
- FLOURIC ACID (FL-AC)
- Soft small stools in the morning after drinking coffee, and again in the evening, with protrusion of the haemorrhoids. Stool pappy, yellowish-brown, fetid, with tenesmus and prolapse of anus. 6-8 evacuations in 24 hours, of “very loose, bright yellow matter and mucus”; diarrhoea from warm drinks; coffee; from drinking warm chocolate (Bilious); after salmon fish; in old people with syphilitic mercurial dyscrasia (Kent, James Tyler). Desires highly seasoned food. Craves cold water. Indifference towards loved ones.
- HYDROCYANIC ACIDUM (Prussic Acid) (HYDR-AC)
- Very useful in loose stools during cholera, especially cholera sicca (dry cholera. Stage of collapse. Involuntary stools, hiccough, and great prostration. Sudden cessation of all discharges. Sudden prostration; long lasting fainting spells resembling apoplectic attacks. Mentally there is fear of imaginary troubles, horses, wagons, houses falling, etc.
- 10.HIPPURICUM ACID (HIP-AC)
- Acts on the external tissues of the eyes, naso-pharynx, joint surfaces, liver and mucous membranes. General muscular soreness < right side.
- 11.LACTIC ACID (LAC-AC)
- Soft, mushy; greenish yellow stools with tenesmus. Sharp pain across lower abdomen before stool. Mentally great discouragement. Lazy and sarcastic.
- 12.MURIATIC ACID(MUR-AC)
- Diarrhoea with much wind; < morning and evening; intolerable anal itching, not > by scratching, smarting and burning in anus; < after a meal; after fruit; from drinking larger beer; during typhoid; abuse of opium. Stools greenish, in typhoid; may pass unnoticed; watery, dark brown, preceded by pains; discharged while urinating; with blood. Protrusion of blue or dark purple hemorrhoids, especially when diarrhoea is occurring in feeble children suffering from gastric atony, muscular debility and threatened marasmus. This acid has elective affinity for blood, producing a septic condition. Patient weak; slides down the bed. Mentally irritable and peevish; fretful. Loud moaning. Great restlessness. Sad, taciturn; suffers in silence.
- 13.NITRIC ACID (NIT-AC)
- Marked action on the muco-cutaneous outlets of the body; sticking pains; as from splinters. Persons who take cold easily and disposed to diarrhoea. Diarrhoea during typhoid; in children of syphilitic parents; in children, with putrid smell from mouth; copious flow of saliva; ulcers in mouth and on tongue; chronic, with intestinal phthisis. Diarrhoea in old people with great weakness (Kent, James Tyler). Bloody stools with tenesmus; putrid, mucous; undigested ; of yellow-white fluid, loose, mornings ; green, slimy, acrid ; pale from deficiency of bile ; pasty and sour ; curdled, mixed with mucus ; contain lumps of casein or flakes of false membrane. After stools, irritable and exhausted. All symptoms better while riding in a carriage.
- 14. OROTICUM ACID (ORO-AC)
- Diarrhea in morning on rising or in afternoon. Flatus during diarrhea, at night, or better from releasing flatus. Large or soft stool. Offensive, yellow. Forcible stools. Mentally anxiety for no apparent reason. Contended feeling, sensation of wellbeing, very cheerful and hopeful.
- 15.OXALIC ACID (OX-AC)
- Morning diarrhoea; stools soft or watery, with colic around navel and pressing in rectum. Diarrhoea: as soon as one drinks coffee; lying down causes return. Aroused about 3 am with gastric and abdominal pain. Condition is worse from motion, and thinking of it. Periodical remissions are often encountered.
- 16.PHOSPHORIC ACID (PH-AC)
- White, watery, involuntary, painless diarrhoea with much flatus; not exhausting. Haemorrhages from bowels in typhoid fever. Diarrhoea in rachitic children, after oranges. Marked debility, producing a nervous exhaustion. First mental; later physical. Mentally the person may seem listless, apathetic, and indifferent with weak memory. Difficult comprehension. Ailments from excesses, grief, loss of vital fluids.
- 17.PICRIC ACID (PIC-AC)
- Diarrhoea with burning and smarting at anus, frequent, with prostration. Stools are soft, light coloured, with tenesmus, yellowish, copious, oily. Stool as if greased, of sweetish smell, as of boiling sap, at night and morning, then with much wind. Patient cannot collect thoughts; quickly prostrated from using mind.
- 18.SALICYLIC ACID (SAL-AC)
- Stools are green; easily flushing; acid, sour, or putrid smelling. Useful in cholera infantum with peculiarly putrid eructations. There will be anxiety; worry, restlessness, yet mild. Melancholic, wants to be quiet; feels faint (weakness).
- 19.SULPHURIC ACID (SULP-AC)
- Stools are fetid, black, or yellow, stringy mucus with sour odor of body, and empty faint feeling in abdomen. Diarrhoea from smell of coffee. Diarrhoea with great debility and nervous prostration; a sensation of trembling all over. Summer diarrhoea from eating bad or unripe fruit; commencing with nausea, sweat, violent colic, pinching and burning in abdomen. Chronic cases of diarrhoea. There is a tendency to do everything in a great hurry.
- 20.TANNIC- ACID (TANN-AC)
- Intestines feel like cylindrical enlargements through walls of abdomen. Abdomen sensitive to pressure but not distended. Painless and bloody discharge from bowels. Foul stools.
CASE
A lean, thin female of about 38 years developed loose stools (6-7 times/day) after sudden demise of her beloved maternal uncle to whom she was much attached. She developed great fear (of catching the infection; uncle died of COVID-19) and anxiety post this incident. Continuous gloomy mood. Loose stools continued for 2-3 days. There was not much expression of exhaustion; urine profuse and frequent. Due to continuous loss of body fluids and decreased desire to eat and drink due to mental state of sadness, she started to feel weak and complained of slight giddiness in the evening on the 3rd day. Blood pressure was found to be 90/60 mmHg.
Following rubrics were consulted from Complete Repertory:
Diarrhoea, weakness, without: PH-AC (4);
Diarrhoea, grief, from: PH-AC (3);
Diarrhoea, fear, from: PH-AC (3);
Diarrhoea, painless: nit-ac. (1), PH-AC (4), SUL-AC (3)
Diarrhoea, loss of fluids, after: ph-ac (1)
Also, it was observed that there was no initial weakness physically but due to mental affections of sudden fear, grief and sadness, she started becoming weak on the physical level as well. Phosphoric acid 200 was prescribed in short intervals of 15 min for 1 hour and then at 2 hours intervals; gave immediate relief. Medicine was repeated at appropriate intervals.
This shows the utility of an acid remedy for management of diarrhea, irrespective of the sphere of exhaustion that could be physical and/or mental; and their scope in reviving the weakened vitality, eliminating the derangements and improving the health of patient.
References
- Roger Zandvoort, Complete Repertory 2020.
- Henry Clay Allen; Keynotes and Characteristics with Comparisons of some of the Leading Remedies of the Materia Medica
- Constantine Hering; The Guiding Symptoms of our Materia Medica.
- John Henry Clarke; A Dictionary of Practical Materia Medica
- William Boericke; Manual of Homoeopathic Materia Medica with Repertory.
- David S. Riley, Materia Medica of New and Old Homoeopathic Medicines.
- Douglass, M.E, Characteristics of Homoeopathic Materia Medica.
