PERCEIVING THE CLINICAL UTILITY OF LESSER KNOWN REMEDIES

DR. BIPIN JETHANI M.D. (HOM.)Reader, Department of Organon of Medicine, Nehru Homoeopathic Medical College, New DelhiE-mail: drbipin.jethani@gmail.com

ABSTRACT: The so called lesser remedies are in fact not any way lesser in the linguistic expression of the word but are merely less often brought into play and most importantly when they are indicated; they do just as good work as any polychrest can achieve. In my short span of clinical experience; I have had occasionally an opportunity of prescribing remedies that have been relegated to the sphere of lesser known remedies. In this paper, I wish to share with the profession the experience that I have so far gained with regards to lesser known remedies.INTRODUCTION: All drugs of very special and unique action, are easily studied, and well worth learning up. The polychrests, "the common drugs of many uses" will serve us ordinarily; and when we have mastered Sulphur, Sepia, Lycopodium, Calcarea, Nux, etc., etc., we are a long way on towards running, fairly easily and successfully, an ordinary out-patient clinic. But the less universally-useful drugs, of very peculiar and distinctive features, are less frequently, yet amazingly helpful. Once mastered, they romp in brilliantly every time, and make prescribing an excitement and a delight. Generally they do not "work out", unless for one who has mastered the secret, that the best work is done with a few of the "strange, rate and peculiar symptoms", fitting the case, rather than with a host of somewhat indefinite general symptoms, which, if politely given precedence, will often only suggest severe al remedies of the polychrest type, and perhaps completely miss the one brilliant and indispensable.

These enlightening words of the great compiler Dr. M.L. Tyler in her drug picture of Lac caninum very aptly underlie the significance of perceiving the enormous therapeutic efficacy of lesser known remedies of our Materia Medica. As the epic Greek poet Homer encapsulated in his famous saying in The Odyssey:Very often a small rock holds back a great wave.

CASE DISCUSSIONS: To begin with; let me narrate a case of a 4 year old female child who happened to suffer from recurrent attacks of vesicular eruptions on face with intense itching and which used to be worse in winters. The itching was worse at night and scratching used to lead to thin discharge. The intra-uterine history of the case brought to the fore fact that mother had suffered from severe vomiting for entire nine months of pregnancy. The further evolutionary history of child revealed that she had suffered from chicken pox at the age of 2 years and her developmental milestones and vaccination status did not give a clue to prescribing. The anamnesis of the case and her desire for sweets and cold water had made me think of Thyroidinum which did not help. In subsequent case perceiving; a crucial aspect of the case as emphasized upon by the parent came to light ---- the child, being full of life and activity, manifested her mental excitability especially at about the night time. She used to wake up from sleep and demanded to play or involve in some frolic activity. In light of my experience in the OPD of Dr. L.M. Khan at National Institute of Homoeopathy where I had seen him prescribe Cypripedium on this strong indication in case of a child suffering from recurrent tendency to cough and cold; I prescribed her Cypripedium 200/ 9 doses. The effect was wonderful and the concomitance of Cypripedium opened the magic door. Gleaning through the pages of ancient pharmacology; I found that the drug Cypripedium was considered a nervine by the eclectics i.e. it was used as nerve tonic, a medicine that acts therapeutically upon the nerves, particularly in the sense of a sedative that serves to calm ruffled nerves. It was reported that this plant was superior to opium for inducing sleep and was once commonly used to treat various nervous disorders.John H. Clarke in his A Dictionary of Practical Materia Medica has stated that: It is indicated in the brain hyperaethesia of children who wake in the night lively and full of play. But in order to more appropriately realize the scope of therapeutic utility of the drug Cypripedium; let us refer to Dr. N.M. Choudhary in his scholarly work A Study on Materia Medica. He lucidly states that:..often such functional irritability and cerebral hyperaesthesia end in convulsions. A few doses of Cypripedium will avert the impending danger.This statement merely re-iterates the significance of homoeopathic system of medicine in aborting in the disease in its nascent stage before it has taken its full pathogenic potential. In fact, the immense capability of this small drug in treating cerebral hyperactivity at the functional stage should open a new vista for exploration of entire therapeutic efficacy of such group of not well proven drugs. A more thorough understanding of the drug Cypripedium further widened the horizon of prescribing. The study of Boerickes Homoeopathic Materia Medica led to appreciation of the ability of this drug to produce Rhus like skin symptoms as was mentioned by him as: The skin symptoms correspond to those of poisoning by Rhus, for which it has been found an efficient antidote.This convinced me of the clinical efficacy of Cypripedium in cases of skin affections with the concomitance of reflex nervous excitement manifested through sleeplessness; peculiarity being unnaturally playful at night. In the tune of elaborating upon the nervines; I would like to share my clinical experience with another of the nervines ---- Senecio aureus. Known as the Wild valerian on account of its marked action on nervous temperaments; it has been often quoted as the Coffea of women. Before I delve into the unfanthomed regions of this so called minor drug; let me illustrate a clinical case that happened to report in my NHMC OPD. This pertains to a 24 yrs. old female suffering from PCOD with her complaints being delayed menses since puberty; the delay in interval gradually increasing to such an extent that her menses had not appeared since last 8 months. She was also suffering from frequent attacks of sore throat especially in damp weather. She had tendency to weight gain and gastric upsets occasioned by taking fried or spicy food stuff. Her mild mannerism and self confessed weeping disposition led me to think of Pulsatilla which I confidently prescribed in 200 potency. However; the results were far from satisfactory and the only things that perhaps held her on to my treatment was attentive listening of her complaints and consolable advices. A deeper understanding of the case revealed her inner state of nervousness and brought to the fore an important symptom -- dysuria appearing around the time that the menses were due to appear. This subtle vicarious expression of the patient of non-appearing menses led me towards a drug which has a marked action on the genito-urinary sphere ---- Senecio aureus. The very important indication of this drug in form of catarrhal affections consequent upon suppression of the natural discharge (in this case menses) and elective affinity for female genitalia and urinary system served as beacon light in this case. But it was Bogers A Synoptic Key of the Materia Medica which opened a new panorama of approach in this case. The first and foremost indication that he mentions in his section on location was FEMALE GENITO-URINARY ORGANS. Besides this; the first of the modifications that he mentions is WORSE PUBERTY i.e. complaints tracing their origin since puberty. Both these aspects fitted the case so very well that it merited further in-depth study.Elaborating in the first line of the body of the drug, Boger has with his brevity in writing mentioned that this drug is of utmost value in cases with Lack of reaction in Genito-urinary sphere. Thus this drug is capable of arousing the vitality in affections of genito-urinary sphere. In fact; Scudder, an eminent medieval physician, wrote:The Senecio exerts a specific influence upon the reproductive organs of the female, and to a less extent upon the male. It relieves irritation and strengthens functional activity. Hence it has acquired the reputation of a "uterine tonic." It may be prescribed in all cases in which there is an atonic condition of ovaries or uterus, with derangement of function.Furthermore; Boger impressed upon the vital import of the doctrine of concomitance practically through the study of drug Senecio when he describes its pathogenesis as:Dysuria; with dysmenorrhoea.Viewed in the light of the Boenninghausens concept of analogy; it may perceived that Senecio is a wonderful drug in case of any urinary symptom having a spatial or temporal association with any menstrual abnormality. Be it amenorrhoea or dysmenorrhoea or menorrhagia etc.; the association of menstrual irregularity with the urinary symptom makes for a strong ground for prescription of Senecio aureus. Like the other members of Compositae; it has a marked influence in causing hemorrhage in this case menstruation. The hallmark of this drug is expressed by Dr. N.M. Choudhary as: Great variety of conditions traceable to non-appearing menses. The same had been conceptualized by Boger as BETTER MENSTRUATION. With all these concepts in mind, Senecio was prescribed in 30 potency and the result was establishment of regular menstrual flow. Another case that is worth mentioning is a case of 38 year old male who was suffering from recurrent sinusitis and had reported in OPD of National Institute of Homoeopathy, Kolkata with c/o regular paroxysms of thick nasal discharge with frontal headache and nasal blockage. The complaint was worse in damp weather and accompanied with occasional difficulty in breathing during sleep. He was an anxiety prone personality and had marked desire for cold food. I prescribed Argentum nitricum which did him no good. A deeper understanding of the case revealed that he was very sensitive to cloudy weather and what was understood as aggravation from damp was in fact extreme sensitivity to electrical changes in the atmosphere. This sensitivity was of such intense degree that he could predict the onset of rains from the intensification of his physical suffering. This was leading me towards drugs such as Rhododendron, Phos., Psorinum etc.In pursuance of the forementioned strikingness; he also stated that he had suffered from severe electric shock at the age of 13 years and what was quite remarkable was his revelation that whenever someone touched him while he touched a metallic object; they could feel the electric current passing through them. On advice of Dr.L.M. Khan; I prescribed him Electricitas 200; unit dose. The patients c/o recurrent nasal blockage and frontal headache improved wonderfully and most significantly; he was able to tolerate the cloudy weather well could no longer predict rain through his body messaging!!!!!Referring to Dr. H.C. Allens masterpiece The Materia Medica of the Nosodes with proving of the X-ray; we find quotes that:Intense nervous anxietyDreads the approach of thunderstorm, suffers intenselyThis study of the proving of Electricitas enabled to grasp the fact that the basis of prescribing in a given case should not be mere cause (severe electric shock in this case) but its non-linear association with effect as perceived through the records of proving (in this case, extreme anxiousness with aggravation from approach of thunderstorm). It is worth mentioning here that Electricitas works especially well in cases of Tubercular diathesis. In fact Dr. Seward has clinically verified that injudicious use of electric baths brought on phthisis. The next case in hand demonstrates the clinical efficacy of the concept of synthetic prescribing so very well popularized by J.T. Kent. This case pertains to a 36 year old patient who had trouble of repeatedly developing nasal blockage with pain at the root of the nose, occasionally extending to supra-orbital region. For the want of time, the first prescription was Sticta 30. He was no better than before when he next reported and when still repeated; there was only very slight improvement.The thread that helped to pull the string of the case was the spotless shirt that he had always been wearing during every visit and which was striking enough to merit questioning about his fastidiousness. He revealed his subtle anxieties with regards to perfect cleanliness. Taking into the fact that he was a chilly patient and the complaint was brought on especially be dry cold air; I prescribed Arsenic alb. 200 but the result was off and on improvement and relapses. It was at this juncture that a smaller remedy again came to the rescue. With the taint of Arsenic fastidiousness and location of root of the nose; the attention turned towards Natrum Ars. This remedy in repeated doses of 30th potency helped the patient remarkably. With regards to Natrum ars.; J.H. Clarke has emphasized in his Materia Medica that the irritating arsenical effects preponderate. This coupled with the Dr. N.M. Choudharys remark that The symptom that should lead to the selection of Natrum ars. is the pain at the root of the nose a symptom greatly characteristic of this remedy was the cornerstone that led to Natrum ars. prescribing.

Having delved on an imponderabilia, vegetable and mineral kingdom drug; I would lastly take up my clinical experience with a little known nosode. To begin with; it is an ode to Master Hahnemann who first of all advocated the therapeutic utility of nosode as highlighted in 56 footnote of the Sixth Edition of Organon The Art of Healing

To attempt to cure by means of the very same morbific potency (per Idem) contradicts all normal human understanding and hence all experience..Moreover, in this way, undoubtedly, certain diseases peculiar to animals may give us remedies and thus happily enlarge our stock of homopathic remedies.In the domain of nosodes; I would like to exemplify the drug Dysentry Co.; a bowel nosode that should be employed on account of its homoeopathic similarity. As Dr. H.C. Allen wrote in The Materia Medica of the Nosodes in context of Medorrhinum:If the symptoms of the patient call for this remedy, it should be prescribed with the same confidence as any other remedy in the Materia Medica, entirely irrespective of the sycotic history in the case. Like every other nosode, it should be prescribed according to its strict indications just as we prescribe Arsenic, Opium or Sulphur, irrespective of its origin or the diagnosisA 32 year old patient had reported with complain of frequent palpitation, vague chest pain and occasional retrosternal heaviness. He also had c/o slight dull ache in left iliac region which was better after meals and recurrent passage of mucus in stool. The stool examination report showed nothing significant. The most striking observation in this case was anxiety writ upon his face a face that spoke a lot of the strains in life that he had undergone. He was a businessman who had set up his own garment export following dispute with his father from whom he had separated. The efforts to settle in a new place of residence with new business had taken on toll on this apprehension prone individual. The apprehensions were always accentuated by his penchant for orderliness. In the backdrop of this information; I thought of drugs such as Argentum nitricum and Arsenic alb. but the other details elicited from the patient did not bring around any of these remedies into the scope of prescribing. The dominance of nervous tension in the aetiopathology of the case with centering of the effect on the intestinal tract made me think of Dysentry-Co. which was prescribed in 202 potency; unit dose coupled with dosage of appropriate counseling. The patient was much better especially with regards to the somatisation of his mental uneasiness.O.A. Julian has explicitly stated in his Materia Medica of nosodesDys. Co. is suited to Nervous types, tuberculinics, with restless mind; restless and apprehensive. This personality trait with the chronic tendency to passage of mucus in stool encompasses the manifestations of Irritable Bowel Syndrome which this patient was suffering from. However, the intensity of anxiousness with its somatic expression and amelioration after eating clinched the issue in favour of the drug Dysentery-Co.To sum up the discussion; I would like just to mention that whatever bit of learning that I have gained rests on the shoulders of stalwarts of homoeopathic horizon who have guided me through their writings or clinical cases.