MY EXPERIENCE WITH KALI BROM IN A CASE OF POLYCYSTIC

OVARIAN SYNDROME
Parul G. Wadhwani MD (HOM)
Reader, Department of Gynaecology and Obstetrics, Nehru Homoeopathic
MedicalCollege and Hospital, Dte. Of AYUSH, Govt. of NCT of Delhi. India.
E mail: drparulwadhwani@gmail.com

Abstract
Polycystic ovarian syndrome (PCOS) is a heterogeneous collection of signs
and symptoms, which is a leading cause of infertility and one of the top
reproductive endocrine disorders in the world today. A 26-yearsoldunmarried female consulted for the samein the gynecology OPD of
Nehru Homoeopathic Medical College & Hospital. The most striking feature
(characteristic or keynote) of the case was pustular acne with unsightly
scars,which led to selection of Kali brom. Three doses of Kali brom 30
relieved the presenting complaints within 2-3 months. Facial hirsutism
also decreased over following months.Ultrasonography repeated after 6
months revealed a normal study.
Keywords
Polycystic ovarian syndrome, homoeopathy, kali brom, characteristic
feature, striking symptom
Introduction
Polycystic ovarian syndrome (PCOS) is a heterogeneous collection of signs
and symptoms, which form a spectrum of mild to severe disturbances of
reproductive, endocrine and metabolic functions. It is a leading cause of
infertility and one of the top reproductive endocrine disorders in the world
today.
While there are a number of definitions of PCOS, the Rotterdam
consensus[1] is the most widely accepted, which requires the presence of
any two of the following:
Oligo/anovulation
Hyperandrogenism
o Clinical (hirsutism or less commonly male pattern alopecia)
or
o Biochemical (raised FAI or free testosterone)
Polycystic ovaries on ultrasoundand exclusion of other aetiologies
(congenital adrenal hyperplasias, androgensecreting tumours,
Cushings syndrome)
The condition was possibly recognized even by the Father of Medicine,
Hippocrates, as he observedthe girls get amazingly flabby and
podgy.fatness and flabbiness are to blame. The womb is unable to
receive the semen and they menstruate infrequently and little.[2]
Two Chicago doctors, Irving Stein and Michael Leventhal, first diagnosed
PCOS in the early 1930s and reported their findings in a 1935 article
published in the American Journal of Obstetrics and Gynecology. Hence, it
was called Stein and Leventhal Syndrome.

The disorder is multifactorial in origin. A genetic etiology is strongly

suspected but the severity and course is determined by the life style,
especially body mass index. The inheritance is X-linked and female
relatives should be screened, as 50% would have PCOS.
The patients may consult for/ present with any of the following complaint:
Irregular or absent menstrual cycles
Hirsutism
and
male
pattern
balding
consistent
with
hyperandrogenism
Subfertility or infertility
Psychological symptoms anxiety, depression, psychosexual
dysfunction, eating disorders
Metabolic features obesity, dyslipidaemia, diabetes
Acanthosisnigricans etc.
Common long term complications of PCOS include:
1. Diabetes mellitus
2. Dyslipidemia
3. Hypertension and cardiovascular disease
4. Endometrial hyperplasia and endometrial carcinoma
5. Sleep apnea etc.
The diagnosis may be confirmed with the help of Ultrasonography or
serological markers viz.
1. Serum FSH and LH (on day 2-3 of menses or any day if
amenorrhoeic)
2. Serum total and free testosterone
3. Serum DHEA (dehydroepiandrostenedione)
4. Serum insulin fasting and PP
5. TSH
6. Serum prolactin
7. Lipid profile
Modern medicine advises the following treatment options depending on
the chief presenting complaint:
Oligomenorrhoea/amenorrhoea:Lifestyle change (510% weight
loss + structured exercise); Combined oral contraceptive pill, Cyclic
progestins; Metformin (improves ovulation and menstrual cyclicity)
Hirsutism: Self-administered and professional cosmetic therapy with
laser technique.
Infertility: Lifestyle change- smoking cessation, optimal weight,
exercise and folate supplementation; advice regarding the agerelated decline in fertility to allow optimal timing of family planning;
Infertility
therapies
may
include
clomiphene,
metformin,
gonadotrophins, surgery and in vitro fertilisation
Cardiometabolic risk: Lifestyle change
Homoeopathic approach
Against the minimalistic approach of dominant medicine, homoeopathy
takes into account not only the complete medical history of the patient but

also herpersonal history including lifestyle, occupational conditions,

familial scenario and psycho-emotional aspect. Considering every
individual as unique as her fingerprint, the focus is to identify the
personality of the female presenting with a kind of PCOS in order to select
an appropriate remedy. Therefore, one woman with PCOS may take a
completely different remedy from another in order to have relief.
Sanchez-Resendiz and Guzman Gomez F. did a research with 36 cases of
PCOS who fitted the mental picture of Pulsatilla, were given Pulsatilla 6C,
4 hourly throughout the day for 2 weeks after the end of menstruation
and this was repeated for 4 consecutive cycles. At the end of the trial 30
of the 36 women had complete disappearance of symptoms and
production of normal ovulating follicles and a further 4 of the 36 became
asymptomatic.[3]
I share with you a case of PCOS successfully treated in the OPD of Nehru
Homoeopathic Medical College & Hospital.
Case Report
A 26-years-old unmarried girl(OPD reg no. 26814) of heavier built and
dark complexion consulted on 22nd May 2012 for PCOS.
Her primary (and obvious) complaint was of severe acne on cheeks,
forehead and chin since college time. The eruptions were painful, pustular
and left behind deep scars and blemishes and aggravated before menses.
She had tried numerous topical applications for them with temporary
relief.
Simultaneously she also noticed hair growth in the chin region. However,
in last one year she noticed a sudden increase in facial hair growth for
which she consulted a local physician who advised an ultrasonography.
24/04/12: Ultrasonography- Both ovaries are normal in size and show
small cysts in the periphery amidst a hyperechoicstroma. Impression
polycystic ovarian pathology suggested.

She also complained of pre-menstrual mucoidal vaginal discharge.

There was also a tendency to take cold easily and post nasal dripping at
every change of weather since childhood. During summers, she suffered
with epistaxis.
Menstrual history
Menarche: 13 years
Cycle: 25/5 days, flow adequate.
LMP: 7-5-12
Past history
H/o severe insect bite with allergic reaction at 15 years of age.
Jaundice 4 years back.
Family history:
Mother: hypertension, uterine fibroids (hysterectomy done)
Father: hypertension
Generals:
Thermal reaction: can tolerate cold weather easily
Thirst: small quantities in small intervals
Desires: sweet, milk, cold drinks, warm food
Stool: unsatisfactory and hard
Perspiration: on upper lip
Sleep: left side, refreshing
Analysis
The most marked and striking feature of the case was the deep scars left
behind by acne.It reminded me of the keynote symptom mentioned under
Kali brom in Henry Clay Allens Keynotes, Acne: simplex, indurate,
rosacea; bluish-red pustular, on face, chest, shoulders; leaves unsightly
scars (Carbo an); in young fleshy women of gross habits.[4]
After going through John Henry Clarkes MateriaMedica (see discussion
below) I gained further confidence in the remedy.
Prescription & follow up
Date
Follow up
22/05/12
13/06/12
25/07/12
26/09/12

Slight improvement in the

acne and constipation was
better
Acne much better; no new
hair growth on chin; bowels
normal; menses regular
Acne
better;
scarring
decreased; no increase in
facial hirsutism and hair on

Prescription
Kali brom 30/ 3 doses to be
taken 6 hourly on day one.
Placebo 30/ tds for 1 month
Placebo 30/tds for 1 month
Placebo 30/tds for 2 months
Placebo 30/tds for 1 month

17/10/12
07/11/12

chin much softer.

Improvement continues.
Face
quite
clear,
no
blemishes,
scarring
decreased;facial
hirsutism
lesser.
Advised
ultrasonography.

Placebo 30/tds for 1 month

Placebo 30/tds for 1 month

27/11/12: Ultrasonography- Both ovaries are normal in size, normal in

position and show normal echo pattern. Impression: sonological study is
within normal limits.

It has been nearly 2 years since she first consulted at NHMC OPD. She
still visits on and off (for seasonal complaints or with someone else) but
her hirsutism has decreased considerably and she continues to be well.
Discussion & Conclusion
Hahnemann laid down the guidelines for characteristic features in
aphorism 153 of Organon wherein he writes, the more striking,
singular, uncommon and peculiar (characteristic) signs and symptoms of
the case of disease are chiefly and most solely to be kept in view; for it is
more particularly these that very similar ones in the list of symptoms of
the selected medicine must correspond to, in order to constitute it the
most suitable for effecting the cure...[5]
The foremost quality of a characteristic feature ought to be striking; that
is to say, a feature that is on your face and you just cant overlook. Even if
it is a pathological feature or a pathognomonic symptom, it needs to be
considered unless totality points strongly in another direction.
In the above-mentioned case, the unsightly scars were most striking
feature and reminded me of the Henry Clay Allens keynote (another
nomenclature of characteristic) symptom of Kali brom (as mentioned
above under analysis).
Drawing an analogy between medicine and music, prescribing on the
characteristics was termed by Henry Newell Guernsey, Adolph von Lippe,
Henry Clay Allen, etc., as keynote prescribing. There is only one keynote
to any piece of music, however, complicated, and that note governs all the
others in the various parts, no matter how many variations, trills

accompaniments, etc., In both the patient and remedy to be selected,

there is and must be a peculiar combination of symptoms, a characteristic
or keynote. Strike that and all the others are easily touched, attuned or
sounded.[6]
I had a similar experience as when I referred to John Henry Clarkes
MateriaMedica, I found, Acne has a very definite relation to the sexual
organs, being especially noticeable at puberty and, in women at the
menstrual period... A number of cases of ovarian cyst have disappeared
under its action, also fibroids and fatty tumours.[7]
William Boericke in his MateriaMedica has also mentioned under the
chapter on Kali brom, Cystic tumors of Ovaries under section female
and Acne of face, pustules under section on skin.[8]
Keynote prescribing may appear novel, and even at first glance
objectionable, prescription is based on a single symptom, but that is not
what it is. The case reported here demonstrates this, and confirms the
efficacy of keynote prescribing as a way to use MateriaMedica guided by
homoeopathic philosophy to add to our storehouse of evidence-based
medicine, the need of the hour.[9]
And the result of three doses of Kali brom 30 has not only helped a
woman regain health and get rid of PCOS but also bolstered my belief in
the teachings of Hahnemann (characteristic features and minimum dose)
that governed the practice of all the stalwarts of homoeopathy.
References:
1. http://humrep.oxfordjournals.org/content/19/1/41/T1.expansion.ht
ml accessed on 9-2-15.
2. Hippocrates. Airs, Waters, Places-Chapter 20-22 accessed on 9-215 at http://www.well.com/~aquarius/hippocrates.htm
3. Sanchez-Resendiz J, Guzman-Gomez F. Polycystic Ovary Syndrome.
BoletinMexicano de Homeopatica, 30; 1997;pp 11-15.
4. Allen HC. Keynotes and characteristics with comparisons of some of
the leading remedies of materiamedica. Economic Homoeo
Pharmacy, Calcutta; Fifth Indian Edition (Enlarged) 1983; pp 154.
5. Hahnemann S. Organon of medicine, 6th ed. B Jain Publishers (P)
Ltd,Delhi; Reprint edition 2004; pp 158
6. Close S. The genius of homoeopathy, Ch XI- Symptomatology.
Pratap Medical Publishers Pvt Ltd.,New Delhi; pp 160.
7. Clarke JH. A Dictionary of Practical MateriaMedica as accessed 0n 92-15 at http://hpathy.com/e-books/dictionary-of-practical-materiamedica-by-j-h-clarke/kali-bromatum-kali-br-3/
8. Boericke W. Pocket manual of homoeopathic materiamedica and
repertory. B Jain PublishersPvt Ltd, Delhi; Reprint edition 1999; pp
365-366.
9. Wadhwani GG. A case of parkinson-plus syndrome resolved using
the 'lost art' of keynote prescribing. AJHM Summer 2012;105:
pp70-75.