Lycopodium
clavatum in a Case of Gilbert’s syndrome
Gilbert
syndrome is a presumably lifelong disorder; it is a common, mild liver disorder,
in which the liver doesn't properly process bilirubin.
Gilbert’s syndrome
affects 3 to 10 percent of the U.S. population. More males are affected then females.
Because males tend to produce higher
levels of bilirubin, a male-to-female ratio is ranging from 2-7: 1, and occurs
in all races (2). This Syndrome may become apparent
shortly after birth; it may not be recognized for many years. It is
rarely diagnosed before puberty because production of bilirubin increases at
this point. It is usually diagnosed around puberty, possibly because of the
inhibition of bilirubin glucuronidation by endogenous steroid hormones. In
older persons, the diagnosis is usually made when unconjugated
hyperbilirubinemia (1, 3).
30% of patients are
asymptomatic, Fatigue, nausea, abdominal pain and
diarrhea may also occur but these are much less definitive in determining the
diagnosis. The mild jaundice may be especially evident. Pigmented skin thickenings,
similar to moles and soft yellow spots (xanthelasma) on eyelids may occur. An
increase in pigmentation on exposure to light and heat are other symptoms of
this liver disorder. Enlargement of the liver and spleen are rarely seen.
Gilbert
syndrome can be diagnosed by a thorough history and physical examination and
confirmed by standard blood tests. Repeated investigations and invasive
procedures are not usually justified for establishing a diagnosis (3).
Homeopathic
concept: Gilbert syndromes
fundamental cause can be psoro syphilitic with few exiting causes like stress, strain, and exposure to heat. In a day to day
practice we are missing this syndrome and treating for other hepatic causes. Few
months back a case was referred to me with clinical diagnosis as Gilbert syndrome. The following is the case.
CASE SHEET
Code: 207B
Name: Mr. M Age: 25Y Sex: M
Occupation: soft wear
engineer Religion: Hindu, weight:
50kgs
Address: Hyd
Marital status: not
married
PRESENTING COMPLAINTS:
Nausea on and off
since 2 years
< Fatty food 2
years,
No work stress,
food > warm food,
Desire fat food 8
months
< riding in a
car or bus 6 months
Loss of appetite since 8months
HISTORY OF PRESENTING COMPLAINTS:
Complaints
developed gradually. Two years back the patient developed nausea, took
allopathic medicines with a family physician for 8 months with partial relief,
then he consulted gastroenterologist, he after doing investigations he
diagnosed the condition as Gilbert’s
syndrome. In spite of his treatment for over a year his symptoms persisted with
every three months remission. With this patron of symptoms he developed anxiety about his health; Contradiction < with
out work stress, he opted for Homoeopathic treatment. Nausea on and off
since 2 years , no particular time , < fatty food ( Puri , Biriyani etc
) on and off since 2 years , desire fat
food 8months , food > warm food ,
< riding in a car or bus since 6 months . He developed loss of
appetite since 8months.
PAST HISTORY:
Since 2 years every 3-4 months similar complaints in spite of allopathic
treatment
FAMILY HISTORY: father and Mother alive with apparently good
health. Maternal or paternal side history he was not able to tell because he
was away from home.
PERSONAL HISTORY:
Appetite:
Diminished
Thirst:
Decreased
Diet: vegetarian
Desires: fats +
Aversions: --------
Bowel
movement: Regular / Satisfactory
Micturation:
normal
Perspiration-
np
Sleep:
refreshing
Dreams: occ dreams which he cannot remember
Habits &
Addictions: -
Sexual
functions: -N
LIFE SPACE INVESTIGATION:
Patient
was brought up in a middle class family. He was brought up with supporting love
and care, with frequent transfers to his father he studied in boarding school,
he was little shy, his schooling and college life were normal and got his
engineering degree. and got job as software engineer. He developed nausea, <
fat foods. Of late he developed anxiety
about his health; Contradiction - intolerant due to present illness.
SOCIO-ECONOMIC AND OCCUPATIONAL HISTORY: Good, no work stress.
INTER PERSONAL RELATIONSHIP: satisfactory, mixes with people when ever it is
needed.
PHYSICAL EXAMINATION:
General
appearance: anxious look.
Built &
nourishment: Thin built,
Skin: normal,
Cyanosis:
Absent
Scalp: N hair:
occ dandruff,
Eyes: n
Sclera: NAD conjunctiva:
Pale
Oral cavity: NA D
Tongue: N
Teeth: hygienic,
Gums: hygienic,
Lips: normal,
Lymph nodes:
not enlarged
Nails;
N
Skeletal
deformity: absent
Edema: absent
VITAL
SIGNS;
Pulse rate: 70
PM
Temperature: N
Resp rate: 15
Blood
pressure: 110/80mmHg
SYSTEMIC EXAMINATION:
Respiratory
system: NAD
Cardiovascular
system: NAD
Gastro-intestinal
system: Abdomen soft, moveable. Liver palpable,
CNS & PNS:
NAD
PROVISIONAL DIAGNOSIS: Gilbert’s
syndrome
INVESTIGATIONS:
Liver and Spleen scan (colloid): Hepatomegaly with multiple
photopenic areas.
Red cell fragility test: 0.42% (0.48 % Nacl)
Complete urine examination: no abnormality
Total Bilirubin: 2.4 mg/dl, Alkaline Phosphatase: 170 U/L
Glucose-6-phosphate dehydrogenase (G6PD): N 185U/10
RBCs
Reticulocytes: 1%.
CLINICAL DIAGNOSIS: Gilbert’s
syndrome
ANALYSIS OF SYMPTOMS:
EVALUATION OF SYMPTOMS:
REPOTORIAL TOTALITY:
1) Anxiety - health; about - own health; his
2) Contradiction - intolerant of contradiction
3) Warm food – desire,
4) Fatty food - agg.
5) Nausea
6) Nausea, riding in a carriage or on the cars,
while
7) Thirst less
RESULTS OF REPERTORIZATION:
ANALYSIS OF REPERTORIAL RESULTS:
Repertrisation was done on Radar software.
Lycopodium clavatum 47/22, Sepia officinalis 47/19, Arsenicum 44/19,
Cocculus indicus 39/18, Pulsatilla 39/16 (as shown in Repertrisation chart)
DISEASE
DIAGNOSIS: Dynamic
chronic fully developed miasmatic disease
MIASMATIC DIAGNOSIS: Psoro – sycotic
SUSCEPTIBILITY: Moderate
REMEDY SELECTED: Pulsatilla
(5, 6)
First
prescription Pulsatilla 30C, in my mind
I wanted to give Lycopodium but as it is a first prescription I thought of
giving Pulsatilla 30C on following
reasons a) fats >( 3) ,b) thirst
less (3) patients expressions were little shy.(5,6)
POTENCY SELECTED:
30C
PLAN OF TREATMENT,
MANAGEMENT & FOLLOW-UP:
22/07/06
Pulsatilla 30c, 3doses, placebo 15days were given,
06/08/06 no
change,
Pulsatilla 30c, 3doses, placebo 15days were given,
20/08/06 no
appetite, nausea is less by 10%,
Lycopodium 30, doses, placebo for 15days were given,
03/09/06 Anxiety about health came down; appetite
increased, nausea is less by 50%, placebo for15days were given,
17/09/06 Anxiety is less, appetite increased, nausea
is less by 80%, and weight went up to 50.5 kgs,
Lycopodium 30, doses, placebo for15days were given,
30/09/06
Anxiety is less, appetite: normal, nausea is less by 80%, able eat fat
prepared items and digest.
Placebo for15days were given.
04/10/06 GC
good, weight 51kgs, no nausea, able to digest every food,
Sulphur 30 as a closing remedy, 3doses was given and placebo for15days were given.
Case was reviewed on 05/04/07 (6months) patient was
able to tolerate all food, earlier every 3months remission was there, which was
not seen.
