HOMOEOPATHIC APPROACH IN THE TREATMENT OF RHEUMATISM THROUGH

CASE STUDIES

*Dr. Neeraj Gupta M.D (Hom.), **Dr. Gufrana Kamal

*Prof. Deptt of Organon of Medicine, Nehru Homoeopathic Medical College & Hosp.,
Defence Colony, New Delhi

**PG Student M.D (Hom) Part-II; Organon of Medicine

ABSRACT

Rheumatism implies any of the several pathological conditions of muscles, joints, bones or
nerves characterised by discomfort and disability. Case studies on rheumatism treated at IPD
of Nehru Homoeopathic Medical College & Hosp. showed improvement after administration
of homoeopathic remedies selected on the basis repertorization through Radar (version 9)
using synthesis repertory.

KEYWORDS: Constitutional, Homoeopathy, Diathesis, Lumbar spondylosis, predisposition

Rheumatism, Sero-negative polyarthritis, Serial potencies, Synthesis Repertory

CASE NO- 1

A 38 years old female patient Mrs. L was admitted in the IPD of NHMC & H on
7/7/12 with the complaint of pain in multiple joints of the body since 8 years, which started
first in feet as swelling & pain for which she took some ayurvedic treatment with little relief
and then gradually pain started in all joints like in ankle, knees, hips, back, neck, shoulder,
elbow, wrist joints, metacarpal & distal interphalyngeal joint. The pain was aggravated in
early morning, during menses, eating rice & curd. The patient also complained of
breathlessness & palpitations since 3 years which was aggravated by walking, climbing stairs
& got ameliorated by holding the chest tightly. She was feeling acute weakness as well.

The patient had a history of fall from bus with injury to the right elbow 2 years back.
She had increased thirst with dry mouth, desire salty food. The mental state of the patient was
irritable & anxious about family. At the time of admission, she was having mild pallor; her
pulse was 106/min, RR 18/min, BP 115/80 mm Hg. On examination, there was slight
swelling of the affected joints with limitation of movements.

Investigations: on 12/6/12: ESR: 53 mm 1hr, RA factor –ve

On 7/7/12; Hb: 8gm%, TLC: 10600/cmm, DLC: P-68 L-28 E-4; ESR: 45 mm 1hr, BSF:
117mg/dl, PP: 140 mg/dl

REPERTORIAL TOTALITY-

1
 1 MIND - IRRITABILITY
2 MIND - ANXIETY - family; about his
3 EXTREMITIES - PAIN - Joints
4 EXTREMITIES - PAIN - Joints - morning
5 EXTREMITIES - PAIN - menses - during
6 CHEST - PALPITATION of heart - walking
7 RESPIRATION - DIFFICULT - walking
8 GENERALS - FOOD and DRINKS - salt - desire

Phos. Calc. Nit-ac. Rhus-t. Nux-v. Ars. Caust. Sulph. Sep. Staph.

6/13 6/12 6/10 5/12 5/11 5/10 5/10 5/10 5/9 5/9

1 3 3 3 3 3 3 3 3 3 3

2 1 1 - 1 - 1 - 1 - -
3 2 2 1 3 3 2 2 2 - 2

4 - - - 4 3 - 1 - - 1

5 1 - 1 - 1 - - - 1 -

6 - 1 1 - - - - - 2 2

7 2 3 2 1 1 3 2 3 2 -

8 4 2 2 - - 1 2 1 1 1

PROVISIONAL DIAGNOSIS- Sero-negative polyarthritis

Medicine selected- Calcarea carb

DATE COMPLAINTS PRESCRIPTION JUSTIFICATION

8/7/12 Acute severe pain in Gaultheria Q/ for local For pain in joints
multiple joints, use as a palliative
palpitations & Ferrum met 30/TDS/4 For anaemia
breathlessness days

13/7/12 Pain in multiple joints- Gaultheria Q/ for local

aggravated, disturbed use
sleep due to pain, Ferrum met
Palpitations, 30/TDS/1day
breathlessness- slightly
better
She also complaint of Cantharis Q/ X gtt/ BD/ As an acute
increased frequency of 1 day remedy for urinary
urination. complaints

2
14/7/12 Palpitations – worse, Calc carb 0/1 TDS/ 2 On the basis of
Breathlessness -same day repertorial totality
Pain in multiple joints- Mag phos 6X/ QID/ 2 As a supportive
same, day treatment.
increased frequency of
urination & disturbed
sleep- slightly better
16/7/12 Palpitations- better Calc carb 0/1 TDS/ 2
Pain in multiple joints- days
same Mag phos 6X/ QID/ 2
increased frequency of days
urination & disturbed Ruta ointment
sleep- slightly better
18/7/12 Palpitations- better Calc carb 0/1 TDS/ 1
Pain in multiple joints- day
same
Increased frequency of
urination & disturbed
sleep- slightly better
19/7/12 Palpitations- better Rhustox 3X/ TDS/ 5 Was given for the
Pain in multiple joints- days stiffness as an
slightly better but pain Mag phos 6x/ TDS/5 acute medicine
and stiffness in both days and
shoulders were
aggravated
increased frequency of
urination & disturbed
sleep- better
25/7/12 Palpitations- better Calc carb 0/1 TDS/ 2 Calc is natural
Pain in left shoulder day chronic of Bell &
joint- better but pain in Mag phos 6X/ TDS/ 2 Rhus tox1
right still persists. day
increased frequency of
urination- absent
27/7/12 Palpitations- better Five phos 6X/ TDS/ 2 As a medicine for
Pain in multiple joints- days general weakness
better
N/C- diarrhoea

4/8/12 c/o loose stool Sulphur 200/ 3 doses/

weakness, stat
thirstlessness
Calc carb 0/2/ TDS/ 2
weeks
Five phos 6x/ TDS / 2
weeks

25/8/12 G. C- better Calc carb 0/2/ BD/ 2

weeks
Five phos 6x/ TDS/ 2

3
 weeks
15/9/12 c/o Fever with cold Rhus tox 30/TDS/ 5
and bodyaches days
Calc carb 0/3/ BD/ 2
weeks

29/9/12 Status quo Calc carb 0/4/ BD/ 2 Next higher

weeks potency of the
Five phos 6x/ TDS/ 2 constitutional
weeks
3/11/12 G.C- Better Calc carb 0/4/ TDS/ 2 Under observation
weeks

Result & Inference- The patient responded to Calc carb in 0/1 as a constitutional remedy
given during her relief phase, while the acute phase was taken care by Gaultheria Q which
relieved / palliated her for the time being. She got relief by Rhus tox 3X & Mag phos 6X for
her acute complaints. She continued in OPD as a follow up case & was given Calcarea (0/1 to
0/4), next higher potencies whenever there was no improvement. Sulphur was also given as a
complementary and intercurrent remedy; it also comes in reportorial totality.

CASE NO- 2

A 65 years female Mrs. AP was admitted in IPD of NHMC on 28 th August 2012 with
3 months history of pain in the back which was more on the right side. The pain was
aggravated while getting up from sitting position & pressure and ameliorated by lying quietly
or sitting. The pain was otherwise dull in character except sometimes when it was electric
shock like. The pain also extended to hip & thighs.

There was history of 2 attacks of typhoid one 15 years & other 2 years back. Also
there was history of tubectomy 25 years back with no other significant family history. Her
bowel movements were irregular with unrefreshing stools & burning in abdomen. She also
had intolerance to fried food which caused flatulence. She was fastidious & dictatorial,
otherwise satisfied with her life.

She was of good built with pulse 105/min, BP 145/80 mm Hg, RR 18/min at the time
of admission. Tongue had indentation of teeth on the right side.

X – Ray reports & MRI showed lumbar spondylosis with degenerative changes &
nerve root compression at the lat. Foramina of L4 to L6.

Diagnosis – lumbar spondylosis

Rubrics -

4
 1 MIND - DICTATORIAL, domineering, dogmatic, despotic
2 MIND - FASTIDIOUS
3 RECTUM - CONSTIPATION - insufficient, incomplete, unsatisfactory stools
4 BACK - PAIN - lumbar region, lumbago - extending to - thighs
5 BACK - PAIN - aching - lumbar region
6 GENERALITIES - FOOD and drinks - fats and rich food - agg.
7 BACK - PAIN - lumbar region, lumbago - lying - amel.

Nux-v. Kali-c. Nat-m. Sulph. Sep. Lyc. Bry. Ars. Nit-ac. Bell.

7/17 6/17 6/16 6/14 6/13 5/13 5/12 5/11 5/10 5/5

1 1 - - 1 - 3 - 1 - 1

2 3 3 3 1 1 - - 3 - -

3 4 4 4 4 3 3 3 1 4 1

4 1 3 1 1 1 3 1 - 1 1

5 4 3 1 4 4 1 4 3 1 1

6 3 3 4 3 3 3 3 3 3 1

7 1 1 3 - 1 - 1 - 1 -

Medicine selected- Nux vom

Date General condition Prescription Justification

29/08/12 Pain in back Aesculus 30/tds/3 On acute totality
extending to hip & days
thighs aggravated by
stooping and rising
from sitting position
and better by
pressure
31/08/12 Pain in back -do- Under observation
extending to hip &
thighs aggravated by
stooping and rising
from sitting position
and better by
pressure-same
01/09/12 Pain in back- same Aesculus 200/tds/1 Next higher potency.
Stool : severe day
constipation For severe
Cascara Q/tds/3 days constipation
04/09/12 Pain in back- same Nux v 30/tds/2 days On the basis of

5
 Pain in right thigh- Repertorial totality
same
Constipation still
same

06/09/12 Pain in back – Xentine 30/ tds/5 Symptomatic for

slightly better days raised blood pressure
Pain in right thigh- Rauwolfia Q/ tds/ 5 Adviced
slightly better days physiotherapy
BP- 150/94mm Hg
10/09/12 Pain in back- slightly Rhus tox 30/tds/5 As acute remedy for
better days the strained condition
Pain in right thigh- of musculature due to
slightly better physiotherapy
N/C Aphthae,
BP – 132/70 mmHg
14/09/12 Pain on back- better Acid nitricum 200/3 As symptomatic
Pain in right thigh- doses remedy for aphthae
better Sac lac 30/tds/3 days
Aphthae-same Boroglycerine for
N/C coryza with local use
headache
17/09/12 Pain in back- better Allium sativa Q/ X For pain in hip, pain
Pain in right thigh- gtt/tds/ 1 day in psoas and
better iliac muscles2. (Ref:
Aphthae- better Boericke’s materia
Coryza with medica)
headache- better
N/C weakness of B/L
legs, BP:152/72
18/09/12 Pain in back- better Sl 30 /tds/ 2days
Pain in right thigh-
better
Coryza with
headache- absent
Weakness B/L limbs-
same BP:114/69
20/09/12 Pain in back – better Arnica 200/3 doses As an acute remedy
Pain in right thigh- S/L 30/ tds/ 4 days for sore bruised pain
relieved after physiotherapy
N/C pain in left thigh Allium sativum
with sore feeling, Q/tds/ 4 days
BP:130/90
25/09/12 Pain in back- better Nux v 200/3 doses Next higher potency
Pain in right thigh- S/L 30/ tds/ 3 days of the constitutional
better remedy
Pain in left thigh-
better
29/09/12 Pain in back- better Mag phos 6 X/tds/2
Pain in right thigh- days

6
 better
Pain in left thigh-
better
N/C bleeding per Lilium tig 30/tds/2 As an acute
vaginum, Heavy days symptomatic remedy
dragging or outward for bleeding P/V
pressing in pelvis, <
walking
01/10/12 Pain in back- better Gettysburg Symptomatic
Pain in right thigh- water30/tds/3 days
better
Pain in left thigh-
better
Bleeding P/V- better
15/10/12 G.C: 75% better S/L30/tds/1 week

Result & Inference - The patient was discharged on 05/10/12. At the time of discharge, the
patient was 75% better.

The patient was given Aesculus 30, 200, Nux vomica 30, 200, Rauwolfia Q, Kali carb 30,
Allium sativum Q, Rhustox 30, Mag phos 6X & Gettysburg water 30.

She was also given physiotherapy exercises, during which she developed bleeding per
vaginum for which she was given Lilium tig 30 to which she responded well.

She responded well to Nux vom 30, Rhustox 30 & Gettysburg water 30 (given as
symptomatic). Her constitutional remedy seemed to be Nux vom to which helped her to
improve well in serial potencies.

CASE NO- 3

A 65 yrs female, Mrs. S, lean thin built was admitted in IPD of NHMC on 3 rd Oct
2012 with pain in bilateral wrist and elbow joints begin on right side, 6 yrs history of pain on
right side of neck aggravated in winters and better by pressure, pain in lower back and right
hip radiated to right thigh after fall aggravated on walking and relived while resting and with
hot application. Pain in legs on walking

There was history of jaundice 20 yrs back and history of fall 6 yrs back. Her appetite
was diminished. Her bowel movement was satisfactory. Tendency to affect right side. She
complained of weakness of memory, there was desire for company.

At the time of admission her BP was - 122/78, P.R- 76 bpm and RR- 12/min. On
examination there was swelling of both wrist joints with pain on motion and ulnar deviation
at both wrists, pain in right knee with crepitations, her SLR was positive on right side. On eye
examination there was pseudophakia with dry eye.

7
Investigations done:

Blood- 0n 3/10/12 Hb: 11 gm%, TLC: 6900/cmm, P63, L 32, E 3, M 2; ESR: 40 mm 1 hr

Blood sugar; F: 62mg/dl, PP: 70 mg/dl

Diagnosis- Polyarthritis with right sided sciatica

Rubrics-

1 MIND - COMPANY - desire for

2 MIND - MEMORY - weakness of memory
3 NECK - PAIN
4 BACK - PAIN - Lumbar region - extending to - Thighs
5 BACK - PAIN - Lumbar region - walking - while
6 BACK - PAIN - Lumbar region - warm applications amel.
7 EXTREMITIES - PAIN - Leg - walking
8 EXTREMITIES - PAIN - Upper limbs - Joints
9 GENERALS - SIDE - right

Kali-c. Bry. Caust. Sulph. Sep. Nux-v. Carb-an. Hep. Ign. Lyc.

7/12 7/11 7/10 7/10 6/11 6/10 6/9 6/9 6/9 5/12

1 3 1 1 1 2 2 - 1 2 3

2 1 2 3 2 3 2 2 3 2 3

3 1 1 1 1 - 1 - - 1 -

4 2 1 - 1 1 1 1 1 - 2

5 2 2 1 2 3 - 2 1 - -

6 - - 1 - - - - - - -

7 - 1 - - - 1 1 1 1 -

8 1 - 1 1 1 - 1 - 1 1

9 2 3 2 2 1 3 2 2 2 3

Medicine selected- Bryonia

Follow ups

Date General condition Prescription Justification

4/10/12 Pain in both elbow and wrist Amm mur 30/tds/ 4 constricting pain
joints, pain ion right side of neck, days in lower limb

8
 pain in lower back radiating to Mag phos 6x/tds/4 days
right hip and thigh, pain in right
leg, breathlessness in morning
8/10/12 Pain in both elbow and wrist Bryonia 30/tds/4 days On the basis of
joints, pain ion right side of neck, reportorial totality
breathlessness in morning- better
pain in lower back radiating to
right hip and thigh, pain in right
leg- better present only while
walking
10/10/12 All complaints- better Bryonia 200/ 3 doses/ Discharged with
stat/1 day 75% improvement
on 11/10/12

Result & Inference: She complained of constricting pain in lower limb especially right side
so Amm mur 30 was given which relieved her and then Bryonia 30 and Bryonia 200 which
came in reportorial totality relieved her about 75%.
A long follow up was not required as she responded very fast within a week’s time. She was
discharged with the advice of some exercises & instructions of avoidance of strain &
maintenance of proper posture.

CASE NO-4

A 51 yrs female, Mrs. C, was admitted in IPD of NHMC on 19 th Sept. 2012 with h/o
pain in low back from 4 yrs and pain in nape of neck from last 4 months. Ten yrs back she
had back injury by falling from stairs, since then pain in lumbar region occurred on and off,
but since last 4 yrs it was progressively increasing. Pain extended to both lower limbs, but
more in right leg. Pain was aggravated by change in position, on rising from bed in the
morning and better by lying on back. Pain in nape of neck extended to right upper limb.

She had suffered from typhoid twice; once when she was 10 yrs old, and second time
at 41 yrs of age. Thermal reaction was towards Hot and had profuse perspiration. She had
desire for sweets and her tongue was coated white at centre. She had become irritable due to
her disease and was easily angered. She preferred to stay in company rather than being alone.

On examination all movements at neck and low back were found to be limited by pain.

Investigation reports as on 7/6/12- ALP-123IU/L, SGOT-24 IU,SGPT-19 IU/L, A/G-9 ,Vit

D3- 2ng/ml(11-40ng/ml), X-Ray LS Spine-Early lumbar spondylosis with Osteopenia, X-Ray
Cx Spine showed degenerative changes in spine , Cx Spondylosis with Rt. sided
Radiculopathy. MRI CS Spine showed Degenerative Spondylotic changes with disc
degeneration & marginal osteophytes. Diffuse Disc bulge at C4-C5 & C6-C7 indenting thecal
sac and encroaching bilateral intervertebral foramina. C5-C6 Disc reveals focal Rt foraminal
disc protrusion compressing Rt C6 nerve root.

9
13/9/12 - MRI LS Spine showed Degenerative changes with annulus tear and posterior disc
bulge at L4-L5 & L5-S1 causing mild thecal sac compression & nerve root indentation. MRI
whole spine showed multiple disc bulges at C4-C5, C5-C6, and C6-C7 compressing on thecal
sac.

Surgery was advised to her for which she was reluctant.

On 19/9/12- Hb: 11.5 gm%; TLC- 6900/cmm; DLC: P-67 L-28 E-2 M-3; ESR: 48 mm 1 hr;
BSF: 71 mg/dl, PP: 90 mg/dl

Diagnosis- Cx Spondylosis with Rt. sided Radiculopathy & IVDP with Spondylotic Changes.

Rubrics-

1 MIND - IRRITABILITY
2 MIND - COMPANY - desire for
3 BACK - PAIN - Cervical region
4 GENERALS - PAIN - Bones
5 BACK - PAIN - Lumbar region - turning
6 BACK - PAIN - Lumbar region - lying - back, on - amel.
7 BACK - PAIN - Lumbar region - morning - rising - bed; from
8 GENERALS - FOOD and DRINKS - sweets - desire
9 PERSPIRATION - PROFUSE
10 GENERALS - SIDE - right

Kali-c. Sil. Lyc. Calc. Bry. Nux-v. Sulph. Nat-m. Thuj. Ars.

9/19 9/17 8/21 8/19 8/18 8/15 8/15 8/13 8/11 7/17

1 3 3 3 3 3 3 3 3 3 3

2 3 1 3 2 1 2 1 - - 3

3 1 2 2 2 2 1 1 1 1 3

4 1 2 2 2 1 1 2 1 1 1

5 - 1 - - 3 2 1 - 1 -

6 2 - - - - - - 2 - -

7 2 2 2 2 - - - 1 1 -

8 2 1 3 2 2 1 3 1 1 1

9 3 3 3 3 3 2 2 3 2 3

10 2 2 3 3 3 3 2 1 1 3

10
Medicine selected- Kali Carb

Follow ups

Date General condition Prescription Justification

20/9/12 Pain in Lumbar & Cervical region Kali carb 30/TDS/6 On the basis of
– same- Tongue coated white in Days repertorial
centre. totality
Had not passed stool since 2 days Physiotherapy was
advised
26/9/12 Pain in Lumbar & Cervical Mag phos 6X/QID/4 For acute pain
Region- slightly better days
Tongue clean & moist
Constipation- better
N/C- pain in right side of head &
right eye

1/10/12 Pain in head & Cervical region – Kali carb LM scale

better 0/1/TDS/2days selected due to
Pain in lumbar region was better Mag Phos advanced
but was again increased since night 6X/TDS/2days pathology &
Stool-D1 satisfactory need for
repetition
3/10/12 Pain in cervical & Lumbar region Kali carb Next higher
was better, but pain in cervical 0/2/TDS/5days potency
region increasing again since
yesterday evening Mag Phos
Pain in Head - absent 6X/TDS/5days
Tongue clean, Stool D1
satisfactory
N/C – sensation of Dizziness &
Nausea since yesterday, No desire
to eat
8/10/12 Pain in lumbar region – better Rhus glabra 200/3 For occipital
Pain in Cervical region increased doses/1 day headache
since 2 days; more felt in occipital
region Mag Phos 6X/TDS/2
Sleeplessness since 3 days Days
Pain in head - absent
Nausea- absent
Dizziness – same
10/10/12 Pain in cervical/occipital region - Kali carb
better 0/2/TDS/2days
Pain in lumbar region and head – Mag Phos
Better 6X/TDS/2days
Nausea & dizziness – Absent
12/10/12 Pain in cervical region - better Kali Kali phos for
Pain in lumbar region and head – Carb0/3/TDS/8days sleeplessness
Better Mag

11
 Nausea & dizziness – Absent Phos6X/TDS/8days
Sleep- decreased Kali phos 6X/HS/8days
N/C-Urine frequency increased
since 2 days
20/10/12 GC 50% better Rhus Tox 30/TDS/3days Unable to move
Pain in cervical region – better Mag due to pain,
Pain in head – better Phos6X/TDS/3days restricted
Pain in lumbar region increased movement after
since yesterday. Unable to move straining due to
due to pain, restricted movement physiotherapic
Nausea & Dizziness – better exercise

23/10/12 All complaints better KaliCarb0/3/TDS/3Days

Mag Phos
6X/TDS/3Days
26/10/12 All complaints –better Kali Carb Next higher
GC 55% better 0/4/TDS/6Days potency
Mag phos
6X/TDS/6Days
1/11/12 All complaints –better Mag Phos 200/TDS/5 Pain in right leg
GC 65% better days > pressure &
SL 30/TDS/5Days heat
6/11/12 All complaints better Patient Discharged
GC 75% better

Result & Inference: The patient was discharged on 6/11/12. At the time of discharge, the
patient was 75% better.
The patient was given Kali carb in LM potency to which she responded well. During the
treatment Mag phos 6x, Kali phos 6x, Rhus tox 30 was also given. She was also given
physiotherapy exercises. Both the medicines & physiotherapy helped her to avert her surgery
& the patient is still under observation & is called for the followup.

Miasmatic view on rheumatology as seen by various stalwarts

Psora- Neuralgic pains may be either psora or pseudo-psora; they are usually relieved by
quiet, rest and warmth. Psora often is worse by motion and better by rest and warmth3.

Sycosis- shooting or tearing pains in the muscles or joints, sycosis, pains in finger or small
joints. Stiffness and soreness, especially lameness, is very characteristic of sycosis. They are
worse by rest, storm or a damp, humid atmosphere and a falling barometer or becoming cold
and the patient is relieved by moving, by rubbing, stretching, in dry, fair weather; heat does
not always relieve a sycotic patient. There are infiltrations of inflammatory deposits, but it
readily absorbs and is never formative as we find in syphilis and tubercular changes, which
are permanent unless dissipated by treatment3.

Kent says “Rheumatism is only the first shadow of the miasm, which is often observed as
soon as the discharge is suppressed, but sometimes not for months after”.4

12
Robert says “There are tearing pains in the joints, which are aggravated during rest,
aggravated during cold damp weather, amel. moving or stretching, ameliorated in dry
weather. There are pains in the small joints with infiltrations and deposits. The troubles in the
joints, where there are deposits of lime salts as in arthritis deformans, are sycotic. The gouty
diathesis has a sycotic base.”5

Syphilis- J H Allen in his the chronic miasm says “What other miasm would produce caries
or destruction of the bones but syphilis? None.” Syphilitic pains are stitching, shooting or
lancinating in the periosteum or long bones of the upper or lower extremities, the syphilitic
pains are worse at night, or at the approach of night; they are also worse by change of
weather, by cold and damp atmosphere.3

Robert says “As we naturally expect, there are a great many skin manifestations with the
syphilitic miasm and in the tubercular dyscrasia. There are pustular eruptions which
suppurate, and eruptions occur especially about the joints or in the flexures of the body.”5

Tubercular joint troubles have increased in osseous tissues, nodular growths similar to
syphilis. The tubercular and syphilitic bone pains are very similar, both as to their character
and times of aggravation. White swelling of the joints or idiopathic synovitis, even the
rheumatic forms have this tubercular element very marked.3

DISCUSSION:
6
The word rheumatism conveys to the mind of the reader, lay or professional, a
general symptomatology of pain that is similar in certain characteristics whether the difficulty
be gout, arthritis, inflammatory rheumatism, or any other disease syndrome, acute or chronic
or from whatever underlying cause, affecting certain groups of tissues. Moreover, the
Hahnemanian disciple learns as a first principle of prescribing that the differentiation of his
remedies lies, not in the difference of the disease entities, but in the differentiation of
modalities and sensations and locations (the parts or tissues affected).

Case wise Miasmatic Analysis7

In case no.1, the miasmatic analysis was done on symptoms as Dyspnoea on

climbing stairs -Pseudo-psora, Palpitation on climbing stairs- Pseudo-psora, Palpitation on
walking with underlying anaemic state – Psora, Desire salty food- Pseudo psora, Pain in
joints agg early morning- Psora, All joint pain of small and large joint- Sycotic.

The predominance of Psora required selecting Calcarea carb that was given in LM
potency from 0/1 to 0/4 helped the patient to improve only after the acute state of her painful
condition was improved by Gaultheria in Q in drop doses. Then Rhus tox as acute in low
potency was helpful in reducing the stiffness & swelling. And as Calc carb is natural chronic
of Rhus tox, was followed later on in next potencies.

In case no.2, the miasmatic analysis was done on symptoms as the pain was
aggravated while getting up from sitting position – Sycosis, Pain ameliorated by lying quietly

13
or sitting- Pseudo-psora, Intolerance fat food- Pseudo-psora, Constipation- Psora. The
prescence of mixed miasmatic state & the chronicity of the disease required to give many
medicines from Aesculus to Nux vomica, Alium sativa, Lilium tig, Gettysburg water in
varying potencies

In case no.3, the miasmatic analysis was done on symptoms as Pain agg winter-
Psora, Pain better pressure- Sycotic, Pain agg walking- Pseudo-psora, Pain better rest-
Pseudo-psora, Pain better hot application- Psora, Memory weak- Psora. There is a mixed
miasmatic state with predominance of Psora. The patient responded to Bryonia, the psoric
medicine, beautifully.

In case no.4, the miasmatic analysis was done on symptoms as Desire for sweets-
Psora, Pain aggravated by change in position- Psora, Pain better by lying on back- Psora,
Pain on rising from bed in the morning- Sycotic, Profuse perspiration- Sycosis, Degenerative
changes in spine- Syphilitic. Although there was a mixed miasmatic state but the patient was
predominately in sycosyphilitic state with advanced pathology as is depicted by her MRI &
X-ray reports of the spine. She was given Kali carb, Mag phos, Rhus tox & Rhus glabra, &
Gettyburg water as sycotic remedies.

THERAPEUTIC INDICATIONS OF THE REMEDIES USED:

1. AESCULUS HIPPOCASTANUM
- Weakness and lameness in back and neck.
- Stiffness of muscles of neck.
- Sense of weakness in spine.
- Constant dull backache, walking almost impossible.
- Hardly able to rise or stoop or to rise after sitting.
- Weakness, lameness and weariness in small of back.
- tearing in small of back on walking.
- Dull aching pain in small of back agg. on walking as if it would break.
- Constant backache in sacrum and across the hips, greatly agg. by stooping forward and by
walking.
- Pain and lameness in each sacro-iliac symphysis, agg. When walking, which is almost
impossible because of the lameness in back; pain is rheumatic in character.

2. AMMONIUM MURIATICUM

14
- Pain in hips as if tendons were too short; must limp when walking; when sitting gnawing
pain in bone.

- tearing pain in anterior & in posterior part of thighs when sitting.

- drawing tension in legs when sitting.

- knees swollen and stiff, stitches in knee joint evenings when sitting.

- Hamstrings painful as if too short.

- Feet go to sleep, cold feet in bed.

-cannot walk erect because of a pain in groins as if sprained.

3. BRYONIA ALBA

- Pain in nape of neck agg. after taking cold.

- Painful stiffness of muscles of right side of neck on moving head toward shoulder.

- Stiffness and tension in nape of neck and back.

- Sharp stitching pain in left trapezius muscle on turning head to left.

- Dull stitches from behind forward between the scapulae, agg. Lying down.

- Stitches under left scapula through to heart & in small of back.

- Dull aching pain in lumbar region.

- tearing pain with stiffness and tenderness of joints and muscles in lumbar and sacral
regions as if one had been beaten agg. By motion and stooping or sitting, > lying down.

- bruised pain in small of back making walking difficult.

- Stiffness in small of back compelling him to walk or sit crookedly.

- pressing drawing pain in small of back and loins, making turning difficult.

- Pain in small of back, agg. by every motion.

4. CALCAREA CARBONICA
- Rheumatic pains in upper cervical vertebrae with stiffness & of muscles of nape of neck
after overstraining in lifting.
- Pain between the shoulders and lower back.

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- Very severe sudden stitches or pressive pain in back especially in dorsal region.
- Sensation of numbness on side on which he has been lying.
- Weakness or intolerable pain in small of back as if strained could hardly rise from a seat.
- Lumbago with violent boring, burning, tearing pain extending downward, with inclination
to move.
- Drawing and tearing pinching in coccyx.
- tearing in all the limbs.
- bruised pain in upper arms and thigh; in long bones and joints; on motion.
- Heaviness and weight of limbs with great fatigue on walking.
- Great weakness and weariness of all limbs.
- shooting pains through all the limbs.
- Limbs go to sleep easily.
- cracking in knees and shoulder.

5. COLOCYNTHIS

The pains of colocynthis are shooting, tearing and sticking in character.

- In the joints a bruised sensation is often present.
- The pains are agg. while at rest except when in the joints, which are agg. on motion; they
are > by hard pressure.
- Feeling of stiffness in muscles of neck on moving head.
- Violent tensive drawing pains in muscles of neck, agg. on motion.
- pain in shoulder blades and back extending into neck.
- Posterior spinous processes of all the cervical and first three dorsal vertebrae sensitive to
pressure.
- Severe stitching pain in small of back agg. from motion.
- Sensation of heaviness in lumbar-sacral region, > from lying on left side.
- severe pain in small of back confined to a small area making him limp, finally becoming so
severe as to be unable to walk.
- Sharp cutting pains run up back, aching in sacro-iliac articulation.
- stitching pain in back so severe he gets upon hands and knees, the only position giving
relief.

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6. FERRUM METALLICUM

- In rheumatic troubles it often affects the left lower and right upper limbs, having especial
affinity for the shoulder joint and deltoid muscle, and being of value in both articular and
muscular rheumatism.
- Its aggravations and ameliorations are marked, and to some extent resemble rhus tox., but
lack the decided aggravation of rhus in wet weather.
- The anaemic condition is almost always an accompanying symptom of ferrum--which is
another marked difference from rhus--and we do not find in it the inflammatory swellings of
rhus tox.
- Neck sore as if bruised, stiff.- neck and shoulder painful when lying on right side. pain
between the shoulders.
- Constant pain along the back, agg. on parts lain upon.
- Lumbago all night, > on rising.
- Jerking sticking pain in small of back when walking, extending toward hips; agg. after
sitting or standing.
- tearing in arms and legs at night.
- stitching tearing pains at night, must constantly change position.
- Contractions of limbs, cramps in limbs.
- swelling of hands and feet.
- Left lower and right upper limbs most affected.

7. FERRUM PHOSPHORICUM

- Acute articular rheumatism.

- One joint after another is affected.
- Wrists and knees lame and swollen.

8. KALI CARBONICUM

- Stiffness of nape of neck, mornings.

- Back of neck stiff with shooting pain through chest.

- Stiffness of left neck with pains extending to scapulae, agg. after waking and laughing.

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- Stiffness with stitching pains in right neck.

- Stiffness between the shoulder blades.

- tearing pains in scapulae.

- Stinging pains in scapulae when in motion.

- Stitches from apex of scapulae to pit of stomach during manual labour.

- drawing pressive pain in small of back.

- Sharp pains in small of back agg. standing or walking or following a fall.

- bruised pain in back while at rest.

- sharp stitching pains in back waking him at 3 a.m. , compelling him to get up and walk
about, which agg..

- Pains shoot from loins into nates.

- stitching pains shooting from back into glutei and thigh.

- Backache as if it would break.

- Pain across sacrum with stiffness in small of back.

- tearing pain in left shoulder joint.

- cracking in shoulder when moving joint.

- Weakness in joints of arms, mornings, arms become numb and cold.

- Throbbing pain in upper left arm, intermittent.

- Weakness, cramps & lameness and stiffness in hands wrists and fingers, numbness of hands
and arms.

- crampy pain & paralytic weakness in hip and knee joints.

- Pain in right hip, agg. every change of position.

- Violent sticking pain in thigh and knee.

- Sharp drawing pains in right knee and thigh, agg. at night.

- Numbness and falling asleep of whole leg.

- Difficulty in managing legs on going up or down stairs.

- Dull tearing pain in sides of knee agg. at night..

- Rheumatic pains agg. at night, as if in bones of leg.

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- Weakness of limbs.

- Pains mostly in upper arms and lower legs.

- Complaints go from above down.

- Pains drawing, tearing, sticking in limbs.

- jerking of limbs on going to sleep.

- Limbs painful when resting upon anything.

- tearing rheumatic pains in bones.

9. MAGNESIA PHOSPHORICA

- Violent rheumatic pains in joints.

- pains in limbs, nape & back- neuralgic, rheumatic, shooting, boring, darting, shifting and
remitting pains in
- excruciating spasmodic pains in sciatic nerve.
- Pains in right leg from hip to ankle, agg. in joints; pains shift with lightning-like rapidity, >
change of position and > warmth of bed.
- Nightly neuralgic pains now in left leg then in right leg; during day perfectly well.
10. NUX VOMICA

- The call for nux vomica may be for almost any form of rheumatism, when associated with
the great leading symptoms, and when the trouble affects the larger muscles and joints.
- tearing pains in paroxysms in nape of neck.
- Stiff neck in cervico-brachial muscles.
- Rheumatism with or without tearing, drawing pains, head drawn to one side, very difficult
to move head.
- Stiff neck with heaviness.
- Burning, tearing, drawing, lancinating or bruised pains in back.
- Pain in back starts in posterior wall of stomach and spreads to under short ribs.
- Sudden stitches in back when turning.
- Backache, must sit up to turn in bed.
- Bruised or broken pains in small of back.
- Lumbago of whole back, pain in lumbar region from lifting.
- Aching, drawing and bruised pains in limbs.
- rheumatism attacking mostly muscles of the trunk and large joints; swellings pale, tensive,
with numbness and twitching aggravations: morning, after eating, touch, from cold, fright, 3
to 4 a.m, motion, jars ; ameliorations: warmth.

11. RHUS TOXICODENDRON

- Rhus tox. is one of the most valuable remedies in rheumatic conditions; it may be effective
in every form of rheumatism, and is often called for because it affects the whole body.

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 - It may be safely chosen when the marked indications are clear; the marked aggravations
and ameliorations of the remedy point its field of usefulness.

- Stiff neck with painful tension.

- pain in cervical muscles as if he had been lying for a long time.

- Pains in shoulders and back with stiffness as from a sprain.

- sticking pains in back while stooping.

- Violent rheumatic pains between scapulae.

- Stiffness in small of back.

- aching in small of back while sitting, as after long stooping.

- bruised pain in small of back when lying quietly or sitting.

- Heaviness and pressure in small of back as if he had received a heavy blow.

- Sudden acute pain in small of back while lifting.

- Violent pain as if back were broken in lumbar region.

- Lumbar pain after a strain.

- Stiffness and lameness in sacrum.

- Pressure on shoulders like a heavy weight.

- Rheumatic pressive pains in left shoulder and arm in deltoid muscle.

- Tearing and burning in shoulder, arm lame.

- Pains in muscles of left shoulder and arm, in bones, while joints are not affected.

- Strain of left shoulder joint very painful for a long time, later becoming immovable.

- Drawing, paralyzed sensation in left arm at night.

- sticking drawing in left arm extending to fingertips.

- pain in left upper arm as if muscles and tendons were strained.

- Aching and numbness in left arm.

- Chronic articular inflammation resulting from sprains.

- Loss of power and stiffness in forearms and fingers.

- Rheumatic pains through wrist joint from side to side following a sprain.

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- Rheumatic pains in hands.

- aching drawing pains in right hand with numbness extending to other parts.

- Rheumatic swelling of hands during wet weather.

- motion of fingers painful, can only move them with pain because of the swelling.

- Pressive pain in hip joint at every step.

- Tension in left hip joint when sitting.

- When lying upon side hip hurts and lying upon back small of back hurts.

- tearing drawing from hip to knee while walking or standing.

- Dull aching pain in right sciatic nerve.

- pain as if sprained in hip, knee and ankle joint.

- Aching, drawing, tearing, tensive pains from injuries to the leg.

- aching pains in both hip joints at every step.

- Pains run in streaks down the limbs.

- Terrible pain in limbs from severe wetting all over, paroxysmal in character, driving him to
desperation.

- After becoming thoroughly chilled gradually becoming stiff and weak until paralyzed.

- tearing in knee and ankle.

- Stiffness of knees and feet.

- tension in knee as if it were too short.

- gnawing pains with swelling of knee in gout.

- Pain in left knee joint which extends down leg, groaning with pain.

- Deep cutting pains in leg, shooting through leg.

- aching pains in legs, unable to rest for a moment.

- Tension and cramps in calves with sensation as if hamstrings were too short.

- Paroxysmal pains in legs from getting wet when warm.

- aching pains in ankles and arch of foot when walking.

- Feet painful as if sprained on rising.

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12. GETTYSBURG WATER2

-Neck muscles rigid. Joints weak. Cannot lift things. Ligaments rigid.
-Sub acute gouty state.
-Of use in sub-acute and chronic rheumatism.
-Sensation of rigidity worse moving. Especially in lumbar region and joints of hips, shoulders
and wrists. Not perceived when quiet. More in morning. Cannot remain long in one position.
-Stiffness of muscles on moving. Pain in ligaments relieved by rest.
Modalities.-Worse, stiffness of muscles on moving. Better rest (ligaments and stiffness of
muscles).
CONCLUSION:

The patient of any kind of Rheumatism when comes in acute pain, either may be
having limitation or restriction of movement or may be having disability so as to use the part
or the limb. The primary task of the homoeopathic physician is to provide relief from pain
which at times is the greatest stigma to cover (by the use of specifics or palliatives) & when
the patient slightly stabilizes, then one can go with the constitutional & miasmatic approach
which will take care of the rest of the diathesis & predisposition & clears off the deep seated
pathology & bring him back to the road of recovery. The miasmatic preponderance will help
us in identifying the remedy that has to be given at that point of time. These kinds of patients
have to have a long term follow up approach & the necessary restriction in terms of diet &
life style management has to be explained to them as per the directions given by master
Hahnemann. Physiotherapy exercises tailored to suit for the need of the individual patient
have an additional supportive role in the management of the rheumatic diseases.

REFERENCES:

1. Kent’s Lesser Writings article on 2nd Prescription; P-425

2. Pocket Manual of Homoeopathic Materia Medica by William Boericke
3. The Chronic Miasms; J H Allen
4. Lectures on Homoeopathic Philosophy; James Tyler Kent
5. The Principles and Art of Cure by Homœopathy; H A Roberts
6. The Rheumatic Remedies; Vol. 1 & 2 by H.A Roberts
7. Miasmatic Diagnosis: practical tips with clinical comparisons; S K Banerjea

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