A case of poly cystic ovarian syndrome Homeopathic cure

The journey to fertility -  A case of  poly cystic ovarian syndrome 

Prof  G R Mohan

M D (Hom)., P G Dip (Env Stud)

Former Principal, Devs Homeopathic Medical College,

Deva nagar, Ankireddypalli, Kesara mandal, R R Disrtict, A

drmohangr@yahoo.co.in

www.drgrmohan.com

Key words: Poly cystic ovarian syndrome, Homeopathic remedies

Introduction:

Poly cystic ovarian syndrome first described by American gynecologists Stein and Leventhal in 1935,  the Poly cystic ovarian syndrome  is a hormonal disorder affecting 10-15% of women, worldwide, irrespective of race or color. The World Health Organization estimates that it affects 116 million women worldwide as of 2010 (3.4% of the women). According  Dr Rajeev Punjabi India witnesses alarming rise in the incidence of  PCOS, India has witnessed about 30 per cent rise in polycystic ovary syndrome (PCOS) cases in the last couple of years. Lack of awareness and lifestyle changes are considered to be the major factor leading to this phenomenon., 1 2

At least 12 follicles  develop in the ovaries (polycystic means 'many cysts'). Cysts are fluid-filled sacs. Increased  testosterone  level,  raised levels  of insulin in the bloodstream is thought to be the main underlying reason to develop PCOS. A high level of  Luteinising hormone  is found in about 4 in 10 women with PCOS this test is suggestive but not diagnostic. ^1,3

Symptoms: menstrual intervals longer than 35 days; less than eight menstrual cycles a year, in some cases, failure to menstruate for four months or longer; and that prolonged periods may be scant or heavier.

Elevated levels of male hormones androgens  lead to Acne Vulgaris ,oily skin, Hirsutism (69%) androgenic alopecia, around the armpits, groin, neck, and breasts dark or thick skin markings and creases , Clitoris swelling, Central Obesity (apple shaped ) BodyMass Index over 27  , Mood disturbance . 74% Infertility and Recurrent Miscarriage are noticed.

Management :

A systematically selected homeopathic remedy has the capacity to correct hormonal imbalance due to poly cystic ovarian syndrome  by stimulating the glands to secrete various hormones in the required manner, on the the basic pathology, miasmatic nature, individual study, a suitable homeopathic similimum  will bring  an excellent change in blood and sonographic reading. Homeopathic remedies would help in the regression of ovarian cysts. Losing 5 percent to 10 percent of weight according to BodyMass Index, can help to restart ovulation, Exercise can help you lose weight. Diet : Low glycemic index foods, diet include whole grains, beans, fruit, vegetables and lean protein , Eating a few small meals rather than three big ones may help even out blood sugar levels

A case  of Poly cystic ovarian syndrome  : Patient by name MS S, aged 20 years, unmarried , student , who was dreaming to get married and conceive , came to me on 10-02-2013 who was medium built, with 64.9 Kg weight, hot patient, very irritable, known case of hypothyroidism since 4 years presented the following symptoms

Presenting complaints:

Menses delayed by 5 months, irregularity since 3 years

Irritability 2 years

Anxiety about health 1year

Haughty since 8 months

Hair over upper lip, neck. 2 years

                                                                                               

Past history:

Since 2007 period is late, was diagnosed as hypothyroidism and kept on allopathic medication, taking medication for P C O S also.

Family history:  F/H hypothyroidism

Personal history

Appetite- Good

Diet- mixed.

Thirst- less.

Desire- Cold food , desire spicy food.

 Aversions/ intolerance- NS.

Bowels- Regular.

Urine- 5/6 times/day. No special. Characteristics.

Sweat- NP

Sleep- refreshing

Habits and addiction : no

Life space investigation.

 She  belongs to an upper middle class family of Hyderabad. Her  father is a business person   . She is a  first child of her parents. Had normal childhood, 3 years back her mother died due to health problem.

 General physical examination

The patient was short stature  64.9  Kg weight, B M I: 25,  no pallor, cyanosis, edema, clubbing or lymphadenopathy.

Systemic examination

 Examination of neck : slight swelling of thyroid gland on deglutition.

 GIT System: abdomen was soft, liver palpable, spleen not enlarged

 CNS System: Nothing abnormal detected

 CVS System: Nothing abnormal detected

 Respiratory System: Nothing abnormal detected

Investigations:

U S Scan on different times : P C O D ( 2009, 2010 & 2012 )

Antverted uterus, Endometrial thickness :

F S H 6. 7.9 ; L H :21.78 ; S Prolactine : 8.8

T S H : 3.78uiu/ml

Clinical diagnosis: P C O D

 Clinical classification :

 Dynamic chronic fully developed miasmatic disease.

 Miasmatic diagnosis

 Psoro -Sycotic and Syphilitic.

 Susceptibility: moderate

 Totality of symptoms :

 Irritability

 Anxiety about health

 Haughty

 Desire for open air

 Desire for cold  Food , desire spicy food 

 Menses late

*         Thirstless

*         Repertorisation chart (attached below) ⁴

*         Phosphorus  and Pulsatilla were the first two remedies emerged on Repertorisation. Reasons for selecting Pulsatilla was due to as it covered  all symptoms with  maximum score. Boericke says  "it is pre-eminently a female remedy , He says that the disposition and mental state are the chief guiding symptoms to the selection of Pulsatilla.

Treatment:

*         10/02/2013   before the total case was taken , on the day one Thuja30C, Five doses were given every 12 the hourly, along with Placebo 5 days .

*          patient came on 26-2-13 no trace of menses Pulasatilla 200c ,5doses were given  with Placebo for 20 days .

*          24-03-13 :  patient came with  no trace of menses Pulasatilla IM, 3doses  were given with Placebo 30 days . 

*         21-04-13 :  patient came  and said that menses appeared on 17-04-13, bleeding was more. Only Placebo 30days  was given. 

*         19-05-13 :  patient came  and said  menstrual bleeding continued  for 20 days, extreme weakness  China 200C, 5 doses ,  Placebo 15days,  Carcinosin 1M , one dose , Placebo 15days  was given.

*         16-06-13 :  patient came  and said weakness reduced, Menses was again delayed 12 days, it appeared on 29-05-13, LM P  was on 17-04-13,  Pulasatilla I0M, one dose  was  given with Placebo 30 days .  I have advised her to undergo U S Scan of the abdomen.

*         14-07-13 :  patient came  and said menses appeared  on 29-06-13, two days bleeding was present, weakness reduced, Placebo 30days . 

25-08-13 :  patient came  with the U S Scan report which was showing Normal study (attached below). Irritation and other symptoms were normal. Carcinosin 1M , one dose , Placebo 15days  was given.Ahoka Q, was given daily .

Discussion :

In the above case  all investigations were pointing towards  Poly cystic ovarian syndrome . since 2009 she is having the problem, took various treatments with out any benefit, as her age was marriage age, any girl wish to get married and concive, but her periods were very irregular, many times she was kept on contraceptive pills to regulate periods and used metformin without any benefit. with that she gained her weight. 2009 to 2013 she has put on 11 kg weight.developed sever anxity about her health and future.

In the conventional treatment Medical treatment Polycystic ovaries are treated with a laparoscopic procedure called "ovarian drilling" Or Reducing insulin resistance by improving insulin sensitivity through medications such as Metformin anti diabetic drug. If fertility is not the primary aim, then menstruation is  regulated with a contraceptive pill . ¹

 Pulasatilla has given good result in regulating menstruation , it has changed her mood, helped Her to shed weight and lastly  Poly cystic ovarian Cysts  vanished with homeopathic remedies. In the above case Carcinosin Burnett was given; as  it coved  Sycotic, Tubercular, Syphilitic miasms, it’s a  Chronic, Intercurrent remedy . Thuja Occidentalis  covered   Psoric, Sycotic, Syphilitic miasms

It's surprising to note that Pulsatilla which is selected  on the basis of repertriation , given to the patient gave success, but following observations were noted.

In Murphy’s repertory  under the rubric  female-Tumors, genitals-ovaries, cysts : 44 remedies are there but Pulsatilla is missing

Synthesis 8.1 V repertory  under the rubric  female-Tumors, genitals-ovaries, cysts : 32 remedies are there but Pulsatilla is missing

Boericke O, repertory  under the rubric  female sexual system -ovaries, cysts dropsy  : 25 remedies are there but Pulsatilla is missing

References :

1) Ganie M A, Kalra S. Polycystic ovary syndrome - A metabolic malady, the mother of all lifestyle disorders in women -2011 [cited 2013 Sep 16]; 15:239-41. Available from: http://www.ijem.in/text.asp?2011/15/4/239/85571

2) http://ayurbhishak.wordpress.com/2010/09/23/%E2%99%A3-india-witnesses-alarming-rise-in-incidence-of-pcos-dr-rajeev-punjabi/

3) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001408/

 4) Hompath Wildfire

Irritable Bowel syndrome & Homoeopathy

Irritable Bowel syndrome - a challenge in medical practice

Prof G R Mohan

(NHJ, Vol 8, no 2, March/April-2006

full length article in Wonders of Homoeopathy an evidence based study

Irritable bowel syndrome a motility disorder involving the entire GI tract, it is a challenge to treat Irritable Bowel Syndrome in clinical practice with high prevalence of one in four. The cause of irritable bowel syndrome is unknown. No anatomic cause is seen. Emotional factors, diet, drugs, or hormones may precipitate or aggravate GI motility. Some patients of IBS have anxiety disorders, particularly panic disorder; major depressive disorder; and somatization disorder. However, stress and emotional conflict do not always coincide with symptom onset and recurrence. This clinical condition, which has long been misunderstood and misdiagnosed, may represent a complex interaction of altered neurochemical mediators in the enteric nervous system with psychosocial and environmental influences. (2).

The pathogenesis of IBS is poorly understood although roles for abnormal gut motor and sensory activity, central neural dysfunction, psychological disturbances, stress and other factors have been proposed.

            Abnormal psychiatric features are recorded in upto 80% of IBS patients, however no single psychiatric diagnosis predominates. An association between prior sexual or physical abuse and development of IBS has been reported.  Forms of sexual abuse associated with IBS include verbal aggression, exhibitionism, sexual harassment, sexual touching and rape. The pathophysiologic relationship between IBS and sexual and physical abuse is unknown. However physical and sexual abuse may result in hyper vigilance to body sensations at CNS level and visceral hypersensitivity at the gut level.

Gender, race, and age all play a role in the prevalence of IBS. Recent studies suggest that in the United States the incidence of IBS is 10% and its prevalence 20%. These numbers are dependent on the diagnostic criteria used as well as on the population studied. Approximately 70% of patients who meet the diagnostic criteria for IBS do not seek medical care; the remaining patients account for 12% of primary care visits. Community-based estimates suggest that up to 30% of patients with a gastrointestinal complaint will have IBS but only a minority of patients diagnosed by a gastroenterologist.

There are two major clinical types of IBS, constipation predominate IBS, and Diarrhea predominate IBS.

In constipation-predominant IBS, constipation is common, but bowel habits vary. Most patients have pain over at least one area of the colon, associated with periodic constipation alternating with a more normal stool frequency. Stool often contains clear or white mucus. The pain is either colicky, coming in bouts, or a continuous dull ache; it may be relieved by a bowel movement. Eating commonly triggers symptoms. Bloating, flatulence, nausea, dyspepsia, and pyrosis can also occur.

Diarrhea-predominant IBS is characterized by precipitous diarrhea that occurs immediately on rising or during or immediately after eating. Nocturnal diarrhea is unusual. Pain, bloating, and rectal urgency are common, and incontinence may occur. Painless diarrhea is not typical and should lead to consider other diagnostic possibilities e.g., malabsorption, osmotic diarrhea, and etc.

The key to diagnosis of IBS is effective history taking, which requires attention to directed, but not controlled, elaboration of the presenting symptoms, history of present illness, past medical history, family history, familial interrelationships, and drug and dietary histories. Equally important are the patient's interpretation of personal problems and overall emotional state. The quality of patient-physician interaction is key to diagnostic and therapeutic efficacy. Patients with IBS generally appear to be healthy. Palpation of the abdomen may reveal tenderness, particularly in the left lower quadrant, (4)

Rome II Criteria for diagnosis of Irritable Bowel Syndrome

Abdominal discomfort or pain with two of the following three features for at least 12 weeks, not necessarily consecutive, during the previous 12 months:

 • Relief with defecation

 • Onset associated with change in stool frequency.

 • Onset associated with change in stool formation.
Supportive Symptoms-
1. Fewer than three bowel movements per week.

2. More than three bowel movements per day.

3. Hard or lumpy stools.

4. Loose or watery stools.

5. Straining during bowel movements.

6. Fecal urgency.

7. Feelings of incomplete evacuation.

8. Passage of mucus during bowel movement.

9. Sensation of abdominal fullness or bloating

Diarrhea-predominant irritable bowel syndrome = one or more of 2, 4, and 6 and none of 1, 3, and 5

Constipation-predominant irritable bowel syndrome = one or more of 1, 3, and 5 and none of 2, 4, and 6 (4)

Symptoms can be triggered by stress or the ingestion of food is 50% higher than for patients who do not fit the diagnostic criteria. These patients undergo more surgical procedures (such as hysterectomy, appendectomy, and cholecystectomy) and have a higher rate of work absenteeism and an increased number of physician visits per year. Moreover, these patients have significantly impaired quality of life even when compared with chronic disease such as diabetes. Upto 40% of referrals to gastroenterologists are IBS. (2,3).

Lactase intolerance is another common condition that can mimic diarrhea-predominant IBS, antecedent event such as a viral gastroenteritis or food-borne illness is important because there is evidence that up to 30% of patients will develop IBS-like symptoms after experiencing Salmonella enteritis,

Laboratory examination:

• Physical exam.
• Blood tests.
• X ray of the bowel: This x-ray test is called a barium enema or lower GI (gastrointestinal) series. Barium is a thick liquid that makes the bowel show up better on the x-ray. Before taking the x ray, the doctor will put barium into your bowel through the anus.
• Endoscopy: The doctor inserts a thin tube into your bowel. The tube has a camera in it, so the doctor can look at the inside of the bowel to check for problems.

The approach by conventional system in the treatment of IBS is without consideration of person as a whole but in Homoeopathic system the successes rate is more due to holistic approach, in considering the mental and physical aspects of the individual. Giving importance to mind in treatment is the need of the hour in IBS; so homoeopathic treatment has edge over other systems

A high-fiber diet should be advised to reduce digestive system irritation. Alcohol, caffeine, and fatty, gassy, or spicy foods should be avoided. Recommended stress management techniques include yoga, meditation, hypnosis, biofeedback, and reflexology. Reflexology is a technique of foot massage that is thought to relieve diarrhea, constipation, and other IBS symptoms.

The following two interesting cases of IBS treated in OPD

C A S E S:

NAME- Mr.G, 35years. Male-Sex, 

Religion- Hindu. Married.

Occupation – Works in a Private Bank.

Date of first visit-13.03.03 (OPD)

Presenting complaints-

·         Burning in throat since 3 years.

·         Irregular bowel habits since 10 months.

History of presenting complaints-

Patient was well before 3-4 years; to start with he developed symptoms of pain in the right hypochondrium, burning pain in throat, sour eructations, regurgitation of food after eating. he was diagnosed as having cholelithiasis and he was operated for it. He was very well up to 5/6 months of operation, but gradually he developed following symptoms.   

Burning in throat since 3 years < Afternoon 2-3 p.m., taking spicy food, excess quantity of food and after any anxiety or tension.

Regurgitation of food and water

Irregular bowel habit-morning at least gets 3 times urgency before 9 a.m. (before going to office, in holidays also he gets for 3 times.)

First –just after raising from bed.

2^nd- mostly after breakfast.

3^rd- commonly before starting for office.

Itching in scalp since 4-5years.

Past history-

Chickenpox in childhood.

Treatment history.

1.Allopathic

2.Homoeopathic-a) Ars.alb200.b) Arg.Nit 200.

Personal history-

Appetite-good, now taking food in small quanties.

Thirst- normal.

Desires –cold drinks.

Aversions-Sweets.

Bowels-3/4 times daily. (3times before 9 a.m.).

Sweat- on exertion, offensive odour.

Sleep –sound.

Dreams –not specific.

Thermal reactions- Likes open air. Likes winter.

Life space investigation- He hails from one middle class family. Now works in a private bank. Happy with his work. Married and having a son of two year. Relationship with family members and others is good. Can’t concentrate in one thing for a long time, low in confidence.

Physical examination- Well nourished, moderate built.

No signs of pallor, icterus, cyanosis, clubbing and edema.

B.P-120/80 mm of Hg.

Pulse rate-75/min, regular, full, and no spl. character.

Heart rate –75/min regular, full, no spl. character

Systemic examination-

GIT- No relevant sign found.

Investigations- Within the normal range.

Clinical diagnosis- Irritable bowel syndrome.

Disease classification: Dynamic chronic fully developed miasmatic disease.

Miasmatic Diagnosis: Mixed miasmatic disease (Predominantly Psoric)

Repertorial totality.

Complete Repertory Selected

Mind- Anxiety.

            Ailments from anxiety.

            Confidence want of self.

            Concentration difficult.

Male genital-   Sexual; Desire increased

Generalities-    Food and drinks sweets aversion.

                        Food and drinks, cold drinks water desires.

Perspiration- Odor- offensive.

Stool-  Frequent.

            Morning.

Throat-            Pain – Burning.

Stomach-Eructations-food of, regurgitation.

Result of repertorisation.

1.      Lyco-26/11.                                               6.Ars.alb-20/10.

2.      Phosp-25/10.                                             7.Caust-20/10.

3.      Merc-22/10.                                               8.Puls-20/10.

4.      Sil-22/10.                                                   9.Sulph-20/10.

Remedy selected.

Lyco 200/ 1 dose on 20/03/2003

Follow up-

27/03/2003	No change in symptoms.	Placebo- 1 dose
8/05/2004	No change in symptoms. Along with previous mental symptoms patient now have a marked aversion to do the official work. As before he has a strong desire for cold drinks, Basing upon these symptoms and as before also Phos. was in the 2nd position in repertorization , Phos 200 planned to be prescribed.	Phosphorus 200C / 1 dose.
22/05/2004	Feels better. Bowel habit reduced to 2 times in morning.	Placebo/1 dose.
29/05/2004	Feels better. Bowel habit once in the morning. Burning pain and regurgitation reduced.	Placebo /1 dose

Case Summary: In this case due importance was given to the mental symptoms of the patient and the case was marked improved after Phos 200 may be due to its highest similarity to the case and as it covering more prominent mental symptoms. 

CASE NO.2

Mr. K, 51yrs/M, Hindu, Married, illiterate, Agricultural laborer, admitted in our IPD, Bed no.31 with the complaints of sensation of fullness of abdomen < after eating, stool >flatus; aching pain in the abdomen on and off with urging to stool < during urging to stool >flatus; constipation, frequent, ineffectual, urging and burning sensation in both soles

Past History

No significant past history.  Took allopathic treatment for the presenting complaints for the last 6 months with only temporary relief

Personal History:

Appetite: reduced                                          Thirst: 5-6 glasses/day.

Desires: Sweets                                               Aversions: sour things

Urine: (D/N): 6-7/0-1                                     Perspiration: only on exertion 

Bowels: Constipated, frequent, ineffectual, urging.

Sleep: refreshed

Thermal state: Ambithermal

Mental generals: Ailments from silent grief, cannot bear contradiction.

Investigations: On 24/06/2004, CBP: Hb%- 13.5gm%, T.RBC-4.8 milli/cu mm, T.WBC-8,000cells, ESR-5mm/1^st hr, 9/2^nd hr; DC-L.60%, L.33%, E.5%, M.2%: Stool analysis-No cyst, No ova, No occult blood, No parasite. FBS, LPT – with in normal limits

Diagnosis: Irritable Bowel Syndrome.

Disease classification: Dynamic chronic fully developed miasmatic disease

Miasmatic Diagnosis: Predominant Psora - Syphilis

Repertorial Totality:

[KT] [Stomach] Desire: Sweets:

[KT] [Stomach] Desire: Sour:

[KT][Abdomen] Fullness, sensation of: Eating: after:

[KT][Abdomen] Fullness, sensation of: Flatus, passing: amel:

[KT][Abdomen] Pain: Aching: Flatus, passing: amel:

 [KT][Abdomen] Pain: Aching: Stool: Urging, during.

[KT][Abdomen] Pain: Aching: Stool: Before:

[KT][Rectum] Constipation: Ineffectual urging and straining

[KT][Extremities Pain] Pain: Burning: Hand: Palm: Night:

[KT][Extremities Pain] Pain: Burning: Foot: Sole: Night:

Repertorial Result: Sulph ^20/9, Lyc ^17/7, Carb.veg ^16/8, Sep ^15/8, Calc.carb ^12/6

Previous Homoeopathic Treatment: Initially Nux vom 200C and Lyco 1M prescribed based upon the prominent physical generals and gastric symptoms but there has been no relief for 15 days, but after careful interrogoration about his life space investigation, he revealed the death of his son 6 months back, after that he was constantly brooding over that matter without expressing outwards and from then onwards started his complaints gradually and cannot bear contradiction 

Follow Ups:

Date	Observation and progress	Treatment
26/06/2004	First prescription (Based on acute emotional causative modality)	Ign 200C/1D
01/07/2004	Complaints slightly reduced.  General’s normal.	S.L / 2 weeks
07/07/2004	Complaints completely reduced. Generals’ normal.  Patient was discharged and advised to attend OP every Thursday.	S.L/ 1 month
15/07/2004	Recurrence of complaints since 3 days. App-reduced, thirst- more, H/o of grief	Nat.m 1M/1D S.L / 2 weeks
19/08/2004	No recurrence of complaints.  Burning pain in the soles reduced completely.	S.L/2 weeks
23/09/2004	No recurrence of complaints.	S.L / 2 weeks
28/10/2004	No recurrence of complaints.  Patient feels better	S.L / 2 weeks
20/01/2005	No recurrence of complaints.	S.L/2 weeks

Case Summary: Mr. K, aged 51 years, developed fullness and aching pain in the abdomen after stool and burning sensation in the soles following his son’s death. He was treated initially with Ign 200C/1D and later Natr.mur 1M/1D as per the case required.  This led to marked improvement as there was no recurrence of complaints and the patient is still under observation and further results awaited.

Bibilography

1) Lynn, Richard B., and Lawrence S. Friedman. Irritable bowel Syndrome In Harrison's  Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998

2) By Rebecca C. Dunphy, MD, and G. Nicholas Verne, MD, Malcom Randall Veterans Affairs Medical Center and the University of Florida College of Medicine in Gainesville.

3)  Manning AP, et al: Towards a positive diagnosis of the irritable bowel syndrome. BMJ 2:653, 1978.

4) Thompson WG, et al.Functional bowel disorders and Functional abdominal pain. Gut 45(suppl II):1143, 1999.

5) Phlip M Bailey, Homoeopathic psychology,B.Jain publications

6) Weatherall D.J, Ledingham G.G and Wavell D.A : Oxford textbook of medicine.  Oxford medical publishers, Oxford, 3^rd edition – 1996.

“  Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of which they know nothing”           - VOLTAIRE, 1694-1778

Prof. G. R. Mohan,     H.O.D, P.G. Dept. of Organon and Phil.                                                                               Dr. Ch.v.Kishore kumar, P.G. Final year.                                                                                                   Dr Amulya Ratna Sahoo, P.G. Final year.