APPROACH &
METHODOLOGY IN DRUG DEPENDANT
ASTHMA (BRONCHO-SPASM)
CASES
By Dr. Subrata
K. Banerjea,
GOLD MEDALIST
B.H.M.S. (HONOURS IN NINE SUBJECTS OF
FELLOW : AKADEMIE
HOMOOPATHISCHER DEUTSCHER ZENTRALVEREIN (
DIRECTOR : BENGAL ALLEN
MEDICAL INSTITUTE
PRINCIPAL : ALLEN
“SAPIENS”, 382,
Tel & Fax No. 44 (0) 1245 505859
E. Mail No.
allencollege@btinternet.com
Website : www.homoeopathy-course.com
METHODOLOGY
APPROACH –
A: CONTAMINATED DRUG DEPENDENT CASES: CASES WITHOUT CLARITY OF SYMPTOMS:
i) In drug dependent asthma cases, when the patient
is on an inhaler and/or steroids; in such cases it is very difficult to get a
clear picture of the case. The artificial chronic disease is superimposed on
the original natural disease (Aphorsim 91), therefore
symptoms are contaminated or suppressed and the patient cannot give a clear
picture e.g., modalities, etc. In such cases, homoeopathic bronchodilators
e.g., Aralia Racemosa, Blatta Orientalis, Aspidosperma, Cassia Sophera, Eriodictyon, Pothos Foetidus etc., can be prescribed on the basis of few
available symptoms (according to §173--§178, Ref. Organon
of Medicine) and gradually the conventional allopathic bronchodilator is
withdrawn [Subrata asks the patient to sip the
homoeopathic bronchodilator medicine prescribed on the basis of few available
symptoms in those drug-dependant asthma cases, therefore considering the
partial symptomatic similarity in accordance with §173--§178. So when the
patient is out of breath and in need of conventional bronchodilator, patient
takes the homoeopathic medicine and tries to defer the conventional medicine as
much as s/he can. In this way, a steroid dependent patient who used to take
steroid/inhaler 8 hourly; can, with the help of homoeopathic medicine now defer
the steroids to 12 hourly, then 24 hourly and so on. In this way the
conventional medication/inhaler etc is gradually weaned off].
In the same way, for pain killer dependent Migraine
cases, the artificial chronic disease is superimposed on the original natural
disease, therefore symptoms are contaminated or suppressed and the patient
cannot give a clear picture for a constitutional medicine as well as the
modalities of the pain are masked. Therefore, the following medicines can be
selected on the basis of few available symptoms, e.g., Acetanilidum,
Anagyris, Bromium, Chionanthus Virginica, Epiphegus, Ferrum Pyro-Phosphoricum, Indium, Iris Versicolor,
Kalmia Latifolia, Lac Defloratum,
Melilotus, Menispernum, Menynanthes, Oleum Animale, Onosmodium, Saponin, Usnea Barbata, Yucca Filamentosa.
Accordingly the conventional allopathic pain killer is gradually
withdrawn and after approximately 50% weaning off of the conventional medicine,
suppressed symptoms surface and now the patient can give much clearer
modalities. This will lead to making a change in the plan of treatment and on
the basis of `MTEK’ a constitutional prescription can now be made.
Similar example for Drug
Dependent Hypertensive cases where the following medicines (Allium
Sativa, Crataegus Oxyacantha,
Eel Serum, Ergotinum, Lycopus
Virginicus, Rauwolfia Serpentina, Spartium Scoparium, Strophanthus
Hispidus) are capable of gradually weaning off the
conventional medication.
ii) Generally experience shows after
approximately 50% weaning off of the conventional medicine, suppressed symptoms
surface and now the patient can give much clearer modalities. This will lead to
making a change in the plan of treatment and on the basis of `MTEK’ a
constitutional prescription can now be made. Through this approach, not only
does the patient gain immediate confidence that homoeopathy works, but can also
wean off the conventional medication to certain extent.
Therefore in this way the conventional medicine
is gradually weaned-off
and I give full control in the hand of the patient (as the patient is also
aware of the side effects of the chemicals of the conventional medicine and
wants to wean-off them). Giving the “weaning off power” in the hand of the
patient, makes him/her feel that s/he is taking control of what s/he is taking
and therefore patients will power of weaning-off the conventional medicine work
as well towards raising of patient’s energy level. I do not advice exactly how
much to wean-off because that should be guided by the G.P. But as I give the
control in the hand of the patient, therefore, get a disclaimer sign by the
patient, as below:
TO WHOM IT MAY CONCERN
(Homoeopathic Consultation with Dr. Subrata K. Banerjea)
I understand that Homoeopathy is a safe
complementary system of medicine and it works gently to stimulate the body’s
own healing power.
I understand that there is no recommendation by
the Homoeopath to stop, vary, reduce or change any medication prescribed by my
G.P. and/or Consultant and if I intend to do so, that will be at my own choice
and my concerned Homoeopath will not be liable for any consequences thereof.
____________________
Signature
Date
________________, 200
___________________________
___________________________
___________________________
(Name and Full Postal
Address)
EIGHT HOMOEOPATHIC BRONCHO-DIALATORS:
TO WEAN-OFF CONVENTIONAL MEDICATION
1)
AMYL. NITROSUM: (i) Asthmatic dyspnoea with
angina.
(ii) Chest:- (a) Oppression,(b) Fullness, (c) Suffocation.
(iii) Anxiety : must have fresh air.
(iv) Cough:-(a) Spasmodic, (b) Suffocative, (c) Paroxysmal.
(v) Constriction:- (a) Throat, (b) Chest, (c) Larynx.
(vi)
Manifestation:- (a) Pulsation, (b) Oppression, (c)
Constriction.
Miasmatics: Psora
(++)-Sycotic(+)- Syphilis (+)- Tubercular (+)
Potency of Choice: Q, 6 C.
2) ARALIA
RACEMOSA:
A = Asthma with wheezing. R
= Right lung : affected
A = Agg. at
I = Inspiration is difficult A = A f.b. (foreign-body) sensation.
(i) Wheezing in throat. Constriction in
chest and throat with a sensation of foreign body in the throat. (ii)
Inspiration is difficult than expiration. (iii) Cough < after lying, < 2
A.M. (iv) Expectoration
is salty and hot.
Miasmatics: Psora
(++)-Sycotic(++)- Syphilis (+)- Tubercular (++)
Potency
of Choice: Q, 6 C; 1M.
3) ASPIDOSPERMA: (i) Want of breath during exertion is
the guiding symptom. (ii) Useful in Cardiac asthma.
(iii) It is the Digitalis of the lungs : broncho-dilatation.
Miasmatics: Psoric
(++)- Syco(++).
Potency of Choice: Q, 30 C ;1M.
4) BLATTA ORIENTALIS: (i) Doctrine of Signature: Cockroach lives in cracks and
crevices; in damp shady places, therefore it is a wonderful medicine for Asthma
for people who lives or works in damp basements, cellars, etc. damp dwelling. Aggravation from damp and rainy weather. (ii) Asthma with bronchitis, especially indicated after Arsenic when this is
insufficient. (iii) Acts best, in stout, or corpulent persons.Seem to act on patients who have a tendency to
obesity. (iv) Much pus like mucus. (v) After the
spasm. for the remaining cough use higher, stop with
improvement.
Miasmatics: Psora
(++)-Sycotic(+++).
Potency of Choice: Q, 30 C ; 1M.
5) CASSIA SOPHERA: (i) Skin diseases (like dandruff, eczema, itching, ringworm
etc.) are associated with bronchial troubles. (ii) More the cough (in asthmatic
patients) and more it is a painful and distressing cough, better it is
indicated. (iii) Asthmatic symptoms with rattling of mucus in the throat but
not much expulsion. (iv) Aggravates during rainy and winter season, (v) <
later part of the evening and past mid-night, towards early morning, better by sitting up. Note:- Cassia sophera is antidoted by smoking or chewing tobacco, so patients,
should avoid them during medication.
Miasmatics: Psora
(++) -Syco(+++)
- Syphilitic
Potency of Choice: Q, 30 C;1M.
6) ERIODICTYON
GLUTINOSUM: (i) Bronchitis followed by
tubercular cough. (ii) Profuse nocturnal sweat and spasm > by expectoration.
(iii) Cough after influenza.
Miasmatics: Psora
(++)-Sycotic(++)- Syphilis (+)- Tubercular (+++)
Potency of Choice: Q, 30 C.
7) POTHOS
FOETIDUS: (i) For asthmatic complaints, which
is caused and are made worse from inhaling any dust. (ii) Difficult,
troublesome respiration; oppression with perspiration. Anguish with
oppression. (iii) Asthmatic symptoms are better by passing stool. (iv) Deep acting Syco-Psoric
remedy
Miasmatics: Psora
(++)-Sycotic(++)- Tubercular (+)
Potency of Choice: Q, 30 C ; 1M ( For Allergic Broncho-spasm).
8) SOLIDAGO VIRGA:
(i) Periodical asthma with nightly dysuria.
(ii) 15 dps doses promotes
expectoration in bronchitis and bronchial asthma, in old people. (iii)
Expectoration:- (a) Profuse, (b) Blood stinged.
Miasmatics: Psora
(++)-Sycotic(++)- Syphilis (+)- Tubercular (+++).
Potency of Choice: Q, 30 C.
Dispensing of the dose of Homoeopathic broncho-dialators:
When the patient is out
of breath and in need of conventional bronchodilator, patient can take any of
the above homoeopathic medicine (or any other medicine, in
accordance with the few symptomatic similarity) and tries to defer the
conventional medicine as much as s/he can. In this way, a steroid dependent
patient who used to take steroid/inhaler 8 hourly; can, with the help of
homoeopathic medicine now defer the steroids to 12 hourly, then 24 hourly and
so on. In this way the conventional medication/inhaler etc is gradually weaned
off].
FLOWCHART FOR GRADUAL WEANING OF
CONVENTIONAL
BRONCHODILATORS (WITH
HOMOEOPATHIC MEDICINE)
INHALER AND/OR STEROID DEPENDENT
BRONCHO-SPASM
APPROACH OF
TREATMENT
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Constitutional Prescribing with the use of
Homoeopathic Organopathic Broncho-dialators
(to gradually wean off the inhalers, etc.) |
As there may be symptoms
but not good symptoms to characterise the patient
and frame a good totality for selecting a constitutional medicine, so better
not to prescribe a constitutional medicine on few vague/common symptoms but
there is scope of employing Homoeopathic Organopathic
medicines. This Organopathic medicine will not only
help to withdraw the allopathic drugs but also in my experience will clear-up
the suppression and bring more symptoms to the surface. |
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To stimulate the vital organs |
Gradually withdraw the drugs |
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Re-assess after 50% - 60% of the withdrawl
of drugs |
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Try constitutional medicine |
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Withdraw in order 1 – Ventolin 2 – Inhaled Steroids 3 – Oral Steroids |
Aim for 10% less in 6 months; long weaning off period;
takes time. If on a constitutional remedy, but inhaler dependent, use
tincture to help decrease dependency. Use constitutional remedy first, this will cover all the
symptoms anyway, tincture will assist as organopathic. Need to withdraw steroids finally,
Homoeopathy won’t work and make any permanent results, if steroid dependent. Tincture - once 50%
of allopathic remedy withdrawn, go to 6c, once 80% withdrawn, go to 30c but
only if tincture is similimum. |
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MONTH
1 |
MONTHS
2-6 |
MONTHS
7-12 |
MONTHS
13-18 |
MONTHS
19-24 |
Allopathic Treatment
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Using: Ventolin (Reliever) 2 puffs when required. Steroid Inhaler (Preventative)
2 puffs twice a day Oral Steroids
– assumed being taken as a one off course. If
not needed, to be gradually reduced. (10% less in 6 mths) Continue
all inhalers and steroids as usual. |
Reduce
(50%),balance with homoeopathic Rx Ventolin (Reliever) 1 puff when required. Need to monitor frequency –
use SOS tincture X 4 hourly or when necessary. Steroid Inhaler (Preventative) try to reduce to 2 puffs once a day over the
period. Oral Steroids
– usually weaned off over a few weeks and then stopped. Aim to reduce frequency of use. |
Reduce
(75%) Ventolin – can patient now do without? Use
SOS tincture when required only, not on a regular basis. Steroid Inhaler
– reduce to 1 puff once a day Mths 7-9, 1 puff
every other day Mths 10-12. Oral steroids
– should have ceased. |
Reduce
(100%) Use
SOS tincture only if and when required Steroid Inhaler
– can patient now do without? (Bear
in mind this takes 2 weeks to build up in the body) |
Reduce
(100%) Use
SOS tincture only if and when required. Ventolin Inhaler should have ceased. Steroid
Inhaler should have ceased. Asthma
under control baring exciting cause e.g. colds,
virus. |
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Homoeopathic Treatment |
Take
Constitutional remedy e.g. Calc Carb 30 – (potency
according to patients vitality). Start
indicated Homoeopathic Tinture 8 hourly to bolster
the lungs e.g. Eriodictyon. Use tincture as SOS as well, if necessary. |
Continue
to take Constitutional Remedy, increase potency if necessary or change remedy
depending on symptoms. Continue
use of tincture as SOS and reduce dose to once a day, if possible. |
Use
SOS tincture as and when required. Continue
Constitutional treatment – deal with any acutes as
they arise. Need to get more symptoms,
may need to open up case with nosode if stuck. |
Continue
Constitutional treatment. |
Continue
Constitutional treatment. Patient
may well have ongoing Homoeopathic treatment for some years - takes 25-40% of
the time they have been ill. |
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MONTH
1 |
MONTHS
2-6 |
MONTHS
7-12 |
MONTHS
13-18 |
MONTHS
19-24 |
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Notes |
May need to use LMs
if patient is unwell or cannot handle aggravations. |
As
time goes on – may need to change tincture as asthma symptoms may change. |
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May
be incurable case, may only be able to palliate or reduce allopathic medicine. |
Every
patient is individual, length of time they have been on Asthmatic drugs must be
taken into account, severity of asthma is also a key
factor. The more severe, the more
gradual the reduction has to be. If they
are using a nebuliser (ventolin)
withdraw very gradually until inhaler only, then
gradually withdraw that – need organopathic tincture
to boost lungs as outlined above. More
difficult to wean off nebuliser, usually very chronic
patients, permanent organ damage may have already occurred.
Withdrawing medication in asthma
Stop inhalers (wean off gradually), then stop
oral steroids
Withdraw in order
1 – Ventolin (reliever)
2 – Inhaled steroids
3 – Internal steroids/Nebuliser
Aim for 10% less in 6 months – long weaning off period,
takes time.
If they are put on a constitutional remedy, but
they are inhaler dependent, then use Tincture to help them decrease inhaler
dependency. If inhaler dependent =
“status asthmaticus” – “got to do something” to help
breathing as can’t do without!
Use the constitutional remedy first – this will
cover all the symptoms anyway, the tincture will assist as it is organopathic and helpful to the lungs.
Need to try and withdraw steroids, Homoeopathy
won’t work if steroid dependent, need to try and withdraw steroids.
Balance Homoeopathy with Bronchodilators with
withdrawal. Law of Similiar acting on physiological level. Use tincture if Ventolin
dependent and start withdrawal 50-60% = get more symptoms.
As soon as patient is clear of SOS medicine – mental
ability to reflect on symptoms is better, need to get more symptoms.
Ventolin/Steroids
mask symptoms.
Dosage of Homoeopathic Broncho-dialator:
6 to 10 drops (according to be Vitality of the
patient) X 4 to 6 hourly X in a cup of luke warm
water X to sip every 5 – 10 minutes, very slowly X during acute attack of
asthma and try to delay the intake / inhaling the drug. In
this way, gradual reduction of the inhaler. If the patient says,
homoeopathic tincture not acting quickly or sufficiently, even then insist to
carry on the tincture as it will and should gradually wean-off
the allopathic medication.
APPROACH-B: NON-SUPPRESSED CASES: CASES WITH CLARITY OF
SYMPTOMS:
MTEK
is an useful memory aid to arriving at a correct
prescription.
M
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= |
Miasmatic Totality |
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T |
= |
Totality of Symptoms |
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E |
= |
Essence (should include gestures, postures,
behaviours etc) |
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K |
= |
Keynotes (which should encompass PQRS
symptoms, refer §153 and §209 of Hahnemann’s Organon) |
When the above criteria are considered and the steps below
followed, a correct prescription can be made.
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Step-I: |
Make the miasmatic
diagnosis of the case i.e. ascertain the surface miasm. |
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Step-II: |
Assess the Totality of Symptoms
+ Essence + Keynotes and PQRS (if any) of the case and formulate the
indicated remedy. |
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Step-III: |
Ensure that the indicated
remedy covers the surface miasm, as diagnosed
in Step I. |
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Step-IV: |
Administer the remedy, which
encompasses the miasm as well as the Totality of
Symptoms. |
So in non surface cases with clarity of symptoms
or on conventional drug dependent cases with the gradual weaning off technieuqe described above, when approximately 40% - 50% of
the drug has been wean off, there are more chances of getting clarity of
symptoms including modality, etc. and therefore at that stage a deep acting
chronic constitutional anti-miasmatic medicine can be prescribed. In those
cases, M-TEK approach can be followed and acess the
surface miasm and prescribe the medicine which covers
the surface miasm as well.
MIASMATICS
OF BRONCHOSPASM
1) PSORIC BRONCHOSPASM: (i)
Hyper-sensitiveness of the tracheo-bronchial tree to
any allergen is psoric. (ii)
Often associated with F/H or P/H of allergy like rhinitis, eczema,
urticaria, even to different kinds of foods. (iii) Nasal allergy à
sneezing à
cough à
dyspnoea à expectoration. (iv) Frequent
congestion of throat with accumulation of much mucus/phlegm. (v) Nasal mucosa:
dry à
then watery mucus à
blow à
dry (++) again. (vi) Expectoration is
usually mucus, scanty and tasteless.
2) SYCOTIC BRONCHOSPASM: (i) Hereditary bronchial asthmas are
generally sycotic. (ii) Without history of
any allergy. (iii) Dyspnoea starts with cough ®
then expectoration ®
Nonasal allergy or rhinitis. (iv) Starts or aggravates in rainy weather. Prefers open
air. (v) Early morning << or late morning < ;
> by movement, lying on abdomen (-some author suggests: Asthma > by lying
on back: Sycosis). (vi) Patient
is compelled to move, which is a characteristic. (vii) Yellowish or greenish-yellow discharge or
expectoration. (viii) Profuse mucus à Nose blocked à
Sinusitis
3) SYPHILO-SYCOTIC BRONCHOSPASM: (i) Starts
with dyspnoea (no manifestation of nasal allergy to
start with). (ii) < in winter,
summer, warmth,
4) TUBERCULAR OR MIXED MIASMATIC BRONCHOSPASM: (i) Dyspnoea on ascending stairs. (ii) The chest is often narrow (pigeon chest), lacking not only in width laterally but also in depth : antero-posteriorly. Sub-clavicular spaces are hollow. One lung is larger than the other is. (iii) Poor-breathers : they have no desire to take a full respiration. (iv) Nasal blockage & thereby mouth breathing. (v) Yellowish expectoration with an odour of old cheese or sulphur smelling. (vi) Patient cannot fully expand the chest, constant desire to hawk. (vii) Teasing cough, expecto