CEDH Magazine - SEPTEMBER 2016 - NUMBER 42

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CLINICALTOOLS International CEDH prescription concepts and consensus

Therapeutic File

Every day Practice

Practitioner’s improvement

Primary hypertension

• Chemoradiation-induced oral mucositis • Juvenile Rheumatoid Arthritis • Obstructive pulmonary disease in children

Polycystic ovary syndrome

Teaching Clinical Homeopathy

CEDH magazine C O N T I N U I N G M E D I C A L E D U C AT I O N C E D H M A G A Z I N E • S E P T E M B E R 2 0 1 6 • N U M B E R 4 2

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SUMMARY

CEDH magazine 3 EDITORIAL ,

Yves Lévêque, MD, 03

42 N°

Published by CEDH, 38, rue des Mathurins, 75008 Paris - www.cedh.org Editor in Chief : Yves Lévêque, MD Editorial board : Yves Lévêque, MD Frédéric Voirin, MD Contributors for this issue : Antoine Demonceaux, MD Hassen Derbel, MD Jean-Claude Karp, MD Ivan Nestorov, MD Guy Villano, MD

Production : Atelier Chalopin, Sérigraphie Editing : Élodie Ther Translator : Bénédicte Clement Illustrations : Fotolia, Gilles Maignaud, Emmanuel Pignier Printing : ISSN : 1950-8832 Legal mention : 0516 T 88691 Publication date : September 2016.

5 CLINICALTOOLS INTERNATIONAL CEDH PRESCRIPTION CONCEPTS AND CONSENSUS Yves Lévêque, MD, 05

9 THERAPEUTIC FILE

Relevance of homeopathy in cardiovascular prevention => Primary hypertension Guy Villano, MD, 09 19 EVERY DAY PRACTICE

Chemoradiation-induced oral mucositis: homeopathic treatment privileging the toxicological approach Jean-Claude Karp, MD, 19

Care management of Juvenile Rheumatoid Arthritis (JRA) based on 4 clinical cases Antoine Demonceaux, MD, 25

Therapeutic efficacy of Antimonium arsenicosum in the acute presentation of obstructive pulmonary disease (OPD) in children Ivan Nestorov, MD, 29 33 PRACTITIONER’S IMPROVEMENT

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Polycystic ovary syndrome: a homeopathic approach

2

Hassen Derbel, MD, 33

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EDITORIAL

CEDH is a big family Yves Lévêque, MD Editor in Chief

he 5th International CEDH Conference, which took place in Chicago, on June 25-26, 2016 was a testimony to the fact that CEDH is a big family.

A widespread family as it brings together more than 20 different countries.

A dynamic family that became closer since the first conference in Lille, followed by the ones in Reims, Los Angeles, Prague, and finally the past one in Chicago. The CEDH shows its willingness to gather homeopathic physicians together to work, share and progress.

A tight family. The CEDH international prescription consensus is a perfect example of these common values. With high quality criteria that we can find both in the depth of the communications as well as in the richness of the topics addressed.

T

The different presentations at the Chicago Conference demonstrated this fact: Elisa Song presented the possibilities of homeopathic treatment in pediatric autoimmune diseases. Robert C. Dumont talked about the homeopathic treatment of cyclic vomiting syndrome. Larry Baskind addressed dermatology via a “skin deep” approach, a complementary presentation to the visualization of elementary dermatologic lesions presented by Daniel Berthier. Christelle Charvet showed the relevance of integrating homeopathy in Obstetrics / Gynecology practice. The homeopathic approach in the treatment of joint pain in an elderly population by Payam Hakimi, followed by the work of Mireille Dom and Dominique Goiran, along with the presentation by John Golden validated the relevance of homeopathy in geriatrics.

A family with a future. The 6th International CEDH Conference, which will be held in Barcelona, October 6-7, 2017 will be our next gathering. Let’s move forward together! ■

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We chose to highlight certain elements of the conference in this CEDH issue: The essential federating concept of the CEDH International Prescription consensus will be detailed. Guy Villano approaches homeopathy in cardiovascular prevention and especially primary hypertension.

An article by Jean-Claude Karp underlines the therapeutic possibilities according to the different stages of oral mucositis. Antoine Demonceaux shared his experience in the treatment of Juvenile Rheumatoid Arthritis based on 4 clinical cases. The efficacy of Antimonium arsenicosum in pediatrics Obstructive Pulmonary Disease (OPD) is validated by a study presented by Ivan Nestorov. Hassan Derbel details the homeopathic approaches in polycystic ovary syndrome.

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CLINICAL

TOOLS

International CEDH prescription concepts and consensus Yves Lévêque, MD Editor in Chief

T

he CEDH decision “house” is a tool to determine the medicine(s), choose the level of dilution, frequency of takes and treatment duration.

Etiology SOAI: Space out according to improvement IPR: Individual Patient Reaction

15-30 CH Anatomo-pathophysiological lesions = 15-30 CH

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CEDH International prescription consensus

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CLINICAL

TOOLS

International CEDH prescription concepts and consensus

1

Determining the medicine

FOR WHAT PURPOSE?

THE ROOF OF THE HOUSE

THE CHRONIC REACTIONAL MODE

corresponds to the etiology, which is a possible pathway to determine the medicine(s).

The question to ask is: after which event or what circumstance did the problem appear?

THE FOUR ROOMS OF THE HOUSE THE BOX ON THE TOP LEFT includes elements yielded by

To help improve or stabilize the patient’s health.

WHAT IS IT? • Expression mode of the disease over time.

• Psoric reactional mode • Psoric-Tuberculinic Reactional mode • Sycotic reactional mode.

• Syphilitic family.

the clinical examination and/or information related to the anatomical-pathophysiological data.

The words chosen are consensual: - aspect; - stage; - localization; - similitude or anatomical-pathophysiological lesion.

FOR WHAT PURPOSE?

THE BOX ON THE TOP RIGHT corresponds to sensations

THE PRESCRIPTION STRATEGY WILL DEPEND ON THE PATIENTS’ NEEDS. - If the reason for consulting are a herpes flare-up on that day, the four rooms of the house and the etiology are enough to establish the prescription.

and one needs to ask the patient “what do you feel exactly?” in order to qualify the clues collected during the interview and refine the determination of the medicine(s).

THE BOX AT THE BOTTOM RIGHT corresponds to modalities, and asking the question “what improves or aggravates the situation” can help you refine the choice for the medicine(s).

THE BOX AT THE BOTTOM LEFT corresponds to

• To reduce the frequency of recurrent episodes.

• Decrease the severity of clinical episodes.

• Correct the expression mode of chronic diseases.

• Stabilize the treatment over time.

- If the reason for consulting is herpes flareups every month before a patient’s periods, then the house must be studied as a whole with a space for the reaction mode and the sensitive type.

concomitant signs that answer the question “what appeared at the same time as the disease?” yielding even more clues to determine the medicine(s).

Sensations, modalities and concomitant signs determine the patient’s individual reaction (PIR), which appears at the same time as the disease.

What is written in black inside the house corresponds to the determination of the medicine.

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Choosing the dilution

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Then, we will consider two useful concepts for chronic treatment: the sensitive type and the chronic reactional mode.

FOR THE ETIOLOGY: the consensual dilution

THE SENSITIVE TYPE

levels are 15 CH or 30 CH Example Monilia albicans, Blatta orientalis…

WHAT IS IT?

FOR THE FIRST ROOM ON THE TOP LEFT: here is

• Common pathological tendencies.

• Shared psycho-behavioral symptoms.

• Sometimes a characteristic morphology.

the anatomical-pathophysiological lesion, corresponding to a high degree of similitude, so the dilutions used will be 15 CH or 30 CH .

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CLINICAL

TOOLS

International CEDH prescription concepts and consensus

Etiology SOAI: Space out according to improvement IPR: Individual Patient Reaction

15-30 CH Anatomo-pathophysiological lesions = 15-30 CH

CEDH International prescription consensus

FOR ALL FOUR ROOMS: The more signs are present, the higher the similitude. This corresponds to the spinning arrow and to the level of dilution that increases according to the number of clues.

3

Determining the frequency of takes FOR THE ETIOLOGY: 5 pellets per day at the beginning and 10 pellets per week afterwards.

FOR THE SENSITIVE TYPE AND THE REACTIONAL MODE: the dilution levels chosen are 15 CH and

What is written in red inside the house corresponds to the determination of the dilution

FOR THE FOUR ROOMS: 5 pellets X times a day. The more severe the clinical situation, the greater X will be, and the more frequent the takes. Afterwards, it is essential to space out the takes according to improvement (SOAI).

FOR THE SENSITIVE TYPE: the frequency of takes goes from 5 pellets per day at the beginning, in order to act fast, to 10 pellets a week.

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30 CH to respect the notion of potential good responders

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CLINICAL

TOOLS

International CEDH prescription concepts and consensus FOR THE REACTIONAL MODE:

IN CONCLUSION:

it is always 10 pellets a day that will be recommended.

this international prescription consensus is a tool to reason and justify the choice of the medicine(s), dilution level, frequency of takes and treatment duration.

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What is written in green corresponds to determining the frequency of takes.

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MEDICINE(S), DILUTION, FREQUENCY OF TAKES, DURATION are the four items that absolutely need to be considered to establish the prescription. â–

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Relevance of homeopathy in cardiovascular prevention

THERAPEUTIC

FILE

Primary hypertension Guy Villano, MD Avignon, France

W

ith homeopathy, can we anticipate, prevent, or delay the onset of primary hypertension? Can we predict and minimize complications related to primary hypertension? Can we potentiate the effectiveness of allopathic hypertension treatments and sustain their efficacy on the

long term? The answer is YES! Which strategies should be implemented to reach that goal? One person does not present with a specific pathology, whenever and for no reason.

We develop pathologies that are similar to ourselves.

THE CURE AND THE PREVENTION PROCESS If we follow this reasoning: Tell me about your pathologies and I will tell you who you are: we are in the cure process.

However, if we think along the line: Tell me who you are and I will tell you about your potential pathologies we are in the prevention process.

This is very important Tell me who you are and I will describe your type of primary hypertension and your cardiovascular risks, which leads us to a better knowledge of the medicine best fitted for a person.

Anticipating in order to be ahead of the pathology and its evolution seems an essential point of the homeopathic therapeutic.

In this context here are a few medicines that I usually use and that I have classified into 5 groups.

1

The recoverable patients Nux vomica, Sulphur, Natrum muriaticum

We are at the genesis stage of the primary hypertension. At this stage the prescribed treatment will either stop the onset of the

SEPTEMBER 2016 CEDH MAGAZINE

Thanks to this individual reactional profile we are in the prevention stage and we can identify, anticipate and treat: - the causes promoting the onset of primary hypertension; - its characteristics related to its clinical evolution; - its potential complications.

The earlier we prescribe the adapted treatment, the earlier we will be able to act on primary hypertension.

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THERAPEUTIC

FILE

Primary hypertension primary hypertension or stop its progression.

- It can help avoid the prescription of allopathic treatments.

- In order to do that it must be prescribed continuously over several months even several years.

Need to deliver a simple prescription to ensure proper treatment compliance by the patient.

MY RECOMMENDED DOSAGE ■ 15 CH, 5 pellets every morning.

NUX VOMICA The inflation spiral

SULPHUR

PROFILE • Young – dynamic – hyperactive, we know the type!

• Perfectionist needs to act, to achieve professional success, to lead and take on responsibilities (it is a small Aurum metallicum).

• Attaches a great importance to his/her professional life.

• He is eager to finish in order to produce something (contrarily to Argentum nitricum).

• Never allows himself/herself to “relax”.

• Inflation spiral: the more he/she does, the more he/she needs to do, up to the point of no return.

RISK FACTORS • Burnout ++, Stress ++.

• Sedentary person.

• Excessive eating and abuse of prescription drugs (sleeping pills, all types of stimulants…).

A « potential » hypertensive patient

PROFILE • Frequently a young, overweight male, often functioning similarly to Nux vomica.

• More rarely a menopausal woman.

• Filled with a lot of energy ++: Sulphur is the medicine of life energy.

• Hyperactive, extrovert, pragmatic with no limits.

• Moderate emotions.

• The sexual component is very important.

• Great adaptability and good sociability.

• Many things to do, to manage often with a seemingly lack of organization, but always reaches his goal thanks to his great work power when he chooses to apply himself.

RISK FACTORS HYPERTENSION • Primary hypertension with a slow onset and progressive evolution with violent paroxysmal flare-ups during periods of burnout, excessive eating or intense work.

• Associated with frontal or occipital headaches, especially in the morning upon waking up or after a nap that does not relieve the patient.

• Often family history of hypertension.

• Living too well and with excesses!

• Eats and drinks life!

• Sulphur lives life to the fullest, and aware of its value, more than others, it leads to major stress because he is afraid to die.

• Yes! Sulphur who has no limits and often goes beyond his abilities to adapt to a situation is a stressed individual.

FEARED COMPLICATIONS • The hypertension sets in permanently.

• Metabolic pathologies = Type 2 diabetes essentially.

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COMPLEMENTARY SATELLITE MEDICINES STRESS

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Aconitum napellus Coffea tosta Adrenalinum 30 CH

VASCULAR Belladonna

HYPERTENSION • The hypertension has a paroxysmal, erratic progression over several years: onset of erratic hypertension flare-ups.

• Sensation of a heavy heart.

• Palpitations at effort or nighttime dyspnea.

• Headaches and tinnitus are important symptoms in monitoring the pathology’s progression.

• Sulphur adapts easily to his/her hypertension and often does not take it seriously.

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS?

FEARED COMPLICATIONS

When needed, Nux vomica will benefit from all hypertensive medicines.

• Progression towards permanent hypertension.

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THERAPEUTIC

FILE

Primary hypertension • Promoted by metabolic pathologies = Type 2 diabetes essentially.

COMPLEMENTARY SATELLITE MEDICINES STRESS • Nux vomica • Ignatia amara • Aconitum napellus • Adrenalinum 30 CH VASCULAR • Arnica montana • Glonoinum

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS? IF NEEDED: • YES to beta-blockers and diuretics.

• NO to vasodilatation drugs (they would only increase the natural congestion of Sulphur).

• Hypersensitivity with communication difficulties.

• Very often the existence of psychological disorders following a deception, rethinking life choices, leading to a loss of self-confidence, often masking a depressive state.

RISK FACTORS • Too much salt.

• Somatization of accumulated, poorly evacuated stress Importance of sentimental treason.

• Natrum muriaticum builds up a wall and triggers his/her hypertension.

HYPERTENSION • Non-symptomatic hypertension with a progressive evolution.

• Sometimes we can encounter violent palpitations, fainting sensations, aggravated when lying on the left side and by movements.

• Sensation of cold around the heart ++.

FEARED COMPLICATIONS • Onset and sustainability of the hypertension.

MY RECOMMENDED DOSAGE ■ Most times, I do not start Sulphur in high dilutions right away and I prescribe a dual dilution = 5 CH , 5 pellets daily then 15 CH than 30 CH , 10 pellets weekly.

This dual dilution is effective and allows for fast results.

In elderly persons, Sulphur can also be encountered but not very frequently.

This person will be a sclerotic hypertensive and should be monitored, quite similar to Arsenicum album. It will be differentiated from Arsenicum album by his/her intolerance to heat, labile hypertension triggering devastating vascular strokes. Angiotensin-converting enzyme (ACE) inhibitors will be indicated.

In this case I prescribe Sulphur in 5 CH daily.

the hypertensive introvert

STRESS • Staphysagria ++ • Ignatia amara • Ambra grisea • Serotoninum 5 CH VASCULAR • Spigelia anthelmia • Aldosterone 15 CH

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS? • One needs to privilege homeopathy for the hypertension of Natrum muriaticum.

• Avoid when possible allopathic medicines.

• When we need to prescribe allopathic medicines, prefer small doses of ACE inhibitors even though they often trigger a spasmodic tracheitis.

• Or small doses of beta-blockers that could lead to muscle asthenia.

• Avoid antihypertensives with a central action (depression).

• Avoid diuretics (Orthostatic hypotension, hyponatremia and dizziness).

• Avoid calcium channel blockers that can trigger panic attacks.

PROFILE • More often a women between 20 and 40 years of age.

• Major emotional and sensory reaction.

MY RECOMMENDED DOSAGE ■ 9 CH daily followed by 30 CH , 10 pellets weekly.

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NATRUM MURIATICUM

COMPLEMENTARY SATELLITE MEDICINES

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THERAPEUTIC

FILE

Primary hypertension

2

The settled patients

COMPLEMENTARY SATELLITE MEDICINES

Lachesis mutus, Iodum, Lycopodium clavatum

STRESS • Aconitum napellus • Ignatia amara • Nux vomica • Coffea tosta • Ambra grisea • Adrenalinum 30 CH VASCULAR • Arnica montana • Glonoinum • Spigelia anthelmia • Veratrum viride • Melilotus officinalis

We are faced with hypertension that has set in.

Sometimes for a little while, sometimes for a long time.

At this stage the homeopathic treatment prescribed continuously over several months or several years will help stop the progression of the hypertension and will support the allopathic treatment which is often necessary, it will be continued at low doses or sometimes stopped.

An “anticipatory” early prescription is essential.

LACHESIS MUTUS A muzzled congested patient

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS?

PROFILE

• Be careful! You will have to be very persuasive otherwise the patient will not follow the treatment, whether allopathic or homeopathic.

• Often allopathic aggravations => vasomotor flashes with calcium channel blockers.

• Cough with ACE inhibitors.

• Hypotension with diuretics.

• Young, full-figured person and/or menopausal woman.

• Touchy and overly emotional associated with mood swings and violent reactions.

• Need to be recognized, need to feel alive.

• The excessive logorrhea hides a deep anxiety and allows Lachesis mutus to exist “as long as I keep talking, I exist”.

• Be aware of a Lachesis mutus who does not express himself/herself physically (language, menstrual periods) or psychologically (emotional territory).

MY RECOMMENDED DOSAGE ■ 15 CH, 5 pellets daily.

RISK FACTORS • Major sensory hyperesthesia.

• Regression of the social status both on professional and familial levels.

• Emotional or social territory loss, leads to a mute Lachesis who develops hypertension and depression (with often consequences: tobacco and alcohol addiction).

• Surgical menopause.

• Grief.

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HYPERTENSION

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• Severe paroxysmal hypertension < in the morning • Major vasomotor lability.

• Posterior headaches especially upon waking up, tinnitus, nose bleed +++.

• Anxiety at bedtime or during the night with cardiac erythrism +++.

IODUM Hypertensive instability

PROFILE • Young or middle-aged patient • Thin • Instability, agitation and ineffective hyperactivity • Irritability, violent, uncontrolled reactions “busybody”

RISK FACTORS • Overactivity.

• High energy consumption.

• Thyroid disorders.

FEARED COMPLICATIONS

HYPERTENSION

• Hypertension that might, if not controlled, become very severe and difficult to manage because of its resistance to all treatments.

• Permanent primary hypertension with paroxysmal flare-ups with pounding, headaches triggering anxiety.

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THERAPEUTIC

FILE

“

Tell me who you are and I will describe your type of primary hypertension and your cardiovascular risks, which leads us to a better knowledge of the medicine best fitted for a person.

• Precordial chest pain with a sensation of heart constriction.

• Palpitations at the slightest exercise.

LYCOPODIUM CLAVATUM

“

Awaiting sclerosis

PROFILE FEARED COMPLICATIONS • Visceral sclerosis often with concomitant thyroid disorders.

COMPLEMENTARY SATELLITE MEDICINES STRESS • Ignatia amara • Nux vomica • Argentum nitricum • Anacardium orientale • Noradrenalinum 30 CH VASCULAR • Arsenicum iodatum • Spigelia anthelmia • Cactus grandiflorus

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS? • No specific precautions.

This dual dilution brings great improvement and avoids complications because of the great reactivity of Iodum.

RISK FACTORS • Lycopodium clavatum does not impose on others by his physical aptitude but rather by his intellectual abilities.

• Often work-related triggering event due to “psycho-intellectual” shock.

• Lycopodium clavatum breaks down when: - he is not at the top of his physical abilities; - when he is under pressure and can’t deliver.

• Does not have the means to achieve his ambition.

• He is not Nux vomica and is quickly overwhelmed by the responsibilities he seeks.

• His physical activity is very limited and mandatory: he exercises because he has to!

• Disorders of lipid metabolism due to poor hepatic function.

HYPERTENSION • Sudden onset of hypertension, but with a slow progression.

• Few symptoms and hardly any concomitant cardiovascular signs.

• Apparently well-tolerated with major visceral risk related to the sclerosis.

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MY RECOMMENDED DOSAGE ■ 5 CH , 5 pellets daily associated to 15 CH , 10 pellets weekly.

• Man – woman around 40-45 years of age.

• Highly emotional, brain reactivity.

• => Difficult social life.

• Major anxiety ++ = Somatization expresses the patient’s ill-being => hypertension.

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THERAPEUTIC

FILE

Primary hypertension FEARED COMPLICATIONS • General arteriosclerosis potentiated by disorders of lipid metabolism.

• Self-destruction.

• He burns up and burns out.

HYPERTENSION COMPLEMENTARY SATELLITE MEDICINES STRESS • Nux vomica because he lives like a Nux vomica.

VASCULAR • Arsenicum iodatum for the arteries.

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS? • Lycopodium clavatum always responds better to multiple therapy and one should avoid increasing doses in monotherapy.

• Always explain and justify the treatment +++.

No antihypertensives with a central action (depression and poorly tolerated: no one touches his brain!).

• Often hereditary, paroxysmal hypertension, hypertension flare-ups with headaches, tinnitus, nose bleeds, and ocular hemorrhages • Violent palpitations aggravated by efforts with sensation of thoracic heat ++.

• Followed by a sensation of emptiness with general weakness.

• Prone to vasovagal syncope.

FEARED COMPLICATIONS • Hypertension with major risk of multivisceral lesional and hemorrhagic complications (heart, kidney, eye, brain).

COMPLEMENTARY SATELLITE MEDICINES MY RECOMMENDED DOSAGE ■ In increasing dilutions 5, 7, 9 CH daily followed by 10 pellets in 15 CH every week = great efficacy.

3

Severe patients Phosphorus, Aurum metallicum, Strontium carbonicum

We are faced with severe hypertension with an important multivisceral lesional component.

At this stage the homeopathic treatment continued over several months even several years will help slow down effectively this lesional aggravation.

Here also there is a great relevance for an early “anticipatory” prescription.

PHOSPHORUS

STRESS • Aconitum napellus • Iodum • Ambra grisea • Ignatia amara • Staphysagria VASCULAR • Arnica montana • Melilotus officinalis • Spigelia anthelmia • Angiotensine II, 30 CH

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS? • Prefer ACE inhibitors, Angiotensin II receptor blockers and diuretics but increase the doses progressively (risk of orthostatic hypotension and watch out for kidney functions).

• We can also give small doses of beta-blockers.

• Avoid antihypertensives with a central action (depression).

The beginning of the lesional

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PROFILE

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• Young adult or middle-aged adult.

• Often specific “Phosphoric Androgenic” morphology.

• Fragile personality with mood swings.

• Alternation of creativity, enthusiasm and apathy, depression.

• “The safety match”.

RISK FACTORS • Life habits.

• Hypersensitivity.

MY RECOMMENDED DOSAGE In Phosphorus similarly to Lachesis mutus and Sulphur (to a lesser degree), there is a big issue with treatment compliance.He fears the vascular accident but does not take his hypertension seriously.This refusal to get treated, denying the truth is a protection. Great importance of the patient-physician relationship.

■ 9 CH daily up to 30 CH once a week.

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THERAPEUTIC

FILE

Primary hypertension AURUM METALLICUM The lesional and his end

PROFILE • Often a man 35-50 years of age.

• Young he is authoritarian, bossy and violent.

• He is very active, a leader and builder.

• Lives life to the fullest, only loves himself. “I shine”.

• Craves power and leadership but is aware of his end: Death!

• The more anxious he gets, the more tyrannical he becomes.

• Old he becomes rigid in his head and arteries.

• Domestic tyrant, sclerotic and stooped, fighting against everyone.

• Depression. Suicidal tendencies because he cannot accept his decline.

• Gold cannot stand being tarnished!

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS? • Without homeopathy, this hypertension is often very difficult to stabilize, even with multidrug therapy.

• Aurum metallicum has a tendency to bradycardia, one needs to be careful with beta-blockers that can trigger chest oppression, fainting.

• Prefer ACE inhibitors.

• Be careful of antihypertensives with a central action (depression).

MY RECOMMENDED DOSAGE ■ 5 CH daily and increasing the dosage progressively, especially in older patients, up to 9-15 CH.

Difficulties in making the patient comply with the treatment.

RISK FACTORS • Life excesses.

• Downside of power and leadership.

• Familial heredity.

• Deep anxiety.

• Ticking clock of time passing by.

HYPERTENSION • Severe hypertension.

• Progressive evolution, punctuated with severe paroxysmal episodes.

• Cephalic congestion.

• Arrhythmia.

• Precordial chest pain with constriction and suffocating = nighttime anxiety.

STRONTIUM CARBONICUM loves heat

PROFILE • 45-50 year-old woman.

• Mix of Aurum and an aggravation of Lachesis improved by heat.

• Plethoric, angry, aggressive, tyrannical, violent.

RISK FACTORS • Menopause essentially.

• Congestive and plethoric tendencies.

HYPERTENSION FEARED COMPLICATIONS • Very important visceral risk.

• In young paroxysmal patient: myocardial infarct • In the older sclerotic patient: arteriosclerosis, coronary insufficiency and arteritis of the lower limbs.

• For both risk of severe ischemic stroke.

COMPLEMENTARY SATELLITE MEDICINES

FEARED COMPLICATIONS • Risk of ischemic stroke.

• Major visceral risk.

• Arteriosclerosis, coronary insufficiency and arteritis of the lower limbs.

COMPLEMENTARY SATELLITE MEDICINES ARTERIES • Arnica montana • Glonoinum • Veratrum viride • Cactus grandiflorus

SEPTEMBRE 2016 CEDH MAGAZINE

STRESS • Aconitum napellus • Nux vomica • Nordrenalinum 30 CH ARTERIES • Glonoinum • Secale cornutum • Cactus grandiflorus

• Severe and unstable hypertension with paroxysmal flare-ups associated with congestive and pounding headaches improved by cold and local heat contrarily to Aurum metallicum.

• Cardiac erythrism.

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THERAPEUTIC

FILE

Primary hypertension WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS? • In this case also, hypertension is often difficult to stabilize without the help of homeopathy, even with multidrug therapy.

• Just like Aurum metallicum, prefer ACE inhibitors and calcium channel blockers.

• Diuretics ±.

• Avoid beta-blockers.

MY RECOMMENDED DOSAGE ■ From 9 CH daily to 30 CH once a week.

• Ischemic stroke with major sequelae.

• Brain sclerosis.

• Multivisceral sclerosis.

COMPLEMENTARY SATELLITE MEDICINES ARTERIES • Arsenicum iodatum • Arnica montana • Spigelia anthelmia

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS? • Privilege ACE inhibitors.

• No antihypertensives with a central action.

• No diuretics.

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Sclerotics who need to be monitored carefully

MY RECOMMENDED DOSAGE ■ 15 CH daily.

Baryta carbonica, Arsenicum album, Plumbum metallicum

They are the ones who will have a mild or cataclysmic ischemic stroke.

Here also homeopathy will help prevent the onset of complications by regulating, with allopathy, hypertension and the sclerosis phenomena.

BARYTA CARBONICA The demented elderly

PROFILE • Cold-sensitive, obsessed and stubborn elderly patient.

• Intellectual and motor slowness.

• Fixed, inexpressive, Parkinsonian-like appearance.

• Complains about his state.

• Improvement by solitude, leading to inertia and cutting off social ties.

RISK FACTORS

ARSENICUM ALBUM The depressive sclerotic

PROFILE • Often a man > 50 years.

• Critical thinking and lucidity. Demanding, tyrannical and possessive.

• Obsessed with death, he is always meticulous. planning his life in order to control it.

• Limiting his areas of interests since he cannot control everything, always.

• Rigid in his head and arteries like Aurum metallicum.

RISK FACTORS • Age. • Arterial sclerosis.

• Obsessed with death, which will lead to somatization and hypertension.

• Age and sclerosis.

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HYPERTENSION

16

HYPERTENSION • Major hypertension with low pulse pressure that became stable after a paroxysmal period.

• Some palpitations when lying on the left side.

• And nothing else = Danger !

FEARED COMPLICATIONS • Coronary pathologies.

• Diastolic hypertension, progressive, with a delayed-onset.

• Some paroxysmal episodes like Baryta carbonica with the possible consequence of an ischemic stroke.

• Cardiovascular erythrism but mostly auricular fibrillation at night or permanent with paroxysmal episodes.

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THERAPEUTIC

FILE

Primary hypertension FEARED COMPLICATIONS

COMPLEMENTARY SATELLITE MEDICINES

• Arterial sclerosis.

• Ischemic stroke.

• Left or global heart failure.

ARTERIES • Secale cornutum • Arsenicum iodatum

COMPLEMENTARY SATELLITE MEDICINES

WHICH ALLOPATHIC/HOMEOPATHIC ASSOCIATIONS?

STRESS • Aconitum napellus VASCULAR • Secale cornutum • Arsenicum iodatum • Naja tripudians • Angiotensin II, 30 CH

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS? • Always explain and justify the treatment just like for Lycopodium clavatum.

• Prefer ACE inhibitors and Angiotensin II receptor blockers.

• No antihypertensives with a central action (depression).

MY RECOMMENDED DOSAGE ■ 9 CH , 5 pellets daily then increase to 15 CH per week or dual dilution.

• Prefer ACE inhibitors.

• Be careful with diuretics (dehydration).

MY RECOMMENDED DOSAGE ■ 5 CH , 5 pellets daily, then increase to 15 CH per week or dual dilution.

5

The more “relaxed” sclerotic patients Calcarea carbonica, Natrum sulphuricum, Thuja occidentalis

The evolution of the hypertension is “calmer”.

Lower risks of paroxysmal ischemic stroke.

Here also homeopathy will be very effective by delaying the onset of sclerotic complications.

CALCAREA CARBONICA the slow one

PLUMBUM METALLICUM The end of the sclerotic patient

PROFILE • Thin, asthenic, sclerotic, amyotrophic, paretic elderly patient.

• Intellectually slow.

• Broody and sad.

• Despondent and disgusted with life.

PROFILE • Man or woman ≥ 40 years.

• Asthenic - Static - Running from physical and intellectual effort.

• Slow to act because he is scared of everything.

• Panic attacks.

• Compensates anxiety by eating.

RISK FACTORS

HYPERTENSION

HYPERTENSION

• Chronic hypertension with very high diastolic pressure associated with bradycardia and thin “lead”-like pulse.

• Slowly evolving hypertension.

• Like Calcarea carbonica.

• Vascular-related dizziness.

FEARED COMPLICATIONS

FEARED COMPLICATIONS

• Generalized arteriosclerosis.

• Heart failure on the right side.

• Non-aggressive parenchymatous sclerosis.

• Arteritis of the lower limbs.

SEPTEMBER 2016 CEDH MAGAZINE

• Age. • Arterial sclerosis.

• Heredity.

• Severe anxiety.

• Overweight.

• Metabolic disorders: Type 2 diabetes.

RISK FACTORS

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THERAPEUTIC

FILE

Primary hypertension COMPLEMENTARY SATELLITE MEDICINES STRESS • Ignatia amara • Gelsemium • Anacardium orientale VASCULAR • Secale cornutum

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS? • Prefer ACE inhibitors.

• No antihypertensives with a central action (depression).

• No calcium channel blockers (panic attacks).

4

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS? • Indication of diuretics and ACE inhibitors.

• No antihypertensives with a central action.

MY RECOMMENDED DOSAGE ■ 9 CH or 15 CH daily.

THUJA OCCIDENTALIS The stuck patient

PROFILE

Infiltration

• Men or woman > 50 years.

• Clogged and sclerotic.

• Depressive. Obsessional melancholic tendency.

• Apathetic, slow to take decisions.

• He/She is indecisive.

• Obsessive behavior, hypochondriac with anticipation anxiety for any type of event, even a minor one.

• Impressionable.

• Thoughts and body are stuck.

PROFILE

RISK FACTORS

• Man or woman ≥ 40 years.

• Inpatient, cranky and in a bad mood especially upon waking up and improved after having eaten.

• Apathetic, whiny, worried and hypersensitive to music and reprimands.

• Anxious, sad and depressed with risk of sudden suicidal impulse.

• Overweight.

• Water infiltration of the fat Sycosis located in the upper body.

RISK FACTORS

FEARED COMPLICATIONS

• Overweight.

• Water infiltration of the fat Sycosis.

• Non-aggressive parenchymatous sclerosis.

MY RECOMMENDED DOSAGE ■ 15 CH daily.

NATRUM SULPHURICUM

HYPERTENSION • Stable and moderate hypertension.

• No concomitant cardiovascular symptoms.

COMPLEMENTARY SATELLITE HYPERTENSION • Progressive hypertension with some paroxysmal episodes.

•Violent palpitations in decubitus.

• Sensation that the heart is filling up the thorax.

FEARED COMPLICATIONS • Non-aggressive parenchymatous sclerosis.

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COMPLEMENTARY SATELLITE MEDICINES

18

STRESS • Ignatia amara • Gelsemium • Anacardium orientale • Serotoninum 5 CH ARTERIES • Spigelia anthelmia • Vasopressine 15 CH

STRESS • Ambra grisea • gnatia amara • Gelsemium • Aconitum napellus ARTERIES • Vasopressine 15 CH

WHICH ALLOPATHIC / HOMEOPATHIC ASSOCIATIONS? • Indication for diuretics.

• No Antihypertensives with a central action (depression).

MY RECOMMENDED DOSAGE ■ 15 CH, every week in the young subject, 5 CH daily for a faster action. ■

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PRACTICE

Chemoradiation-induced oral mucositis Homeopathic treatment privileging the toxicological approach

Dr Jean-Claude Karp, Troyes

I

n the field of chemotherapy, the acute toxicity of the drugs administered is such that the individual reaction has very little impact on the clinical expression of early secondary side effects. In the Materia Medica for Phosphorus1, we can read: “In lesional pathology, the histopathological similitude should be

considered first. The characteristic symptoms of the individual reaction fade away faced with the clinical evidence of the lesion”. This implies to privilege the symptoms of the Materia Medica corresponding to the acute toxicology of the homeopathic medicine.

1

Oral mucositis Whereas stomatitis is an inflammation of the oral mucosa, oral mucositis groups all symptomatic lesions of the mucous membranes; Oropharyngeal; Pharyngeal-oesophageal and the entire digestive system. 40% of patients undergoing chemotherapy develop oral mucositis. The rate goes up to 100% for certain treatments, especially for ENT and hematologic cancers. This illustrates the prevalence of the toxicology on the patient’s individual reaction.

PHASE 3: AGGRAVATION OF PRIMARY LESIONS Via a positive feedback phenomenon specifically related to cell destruction that aggravates the lesions.

PHASE 4: SECONDARY RESPONSE From D10 to D14, bacterial colonization promotes tissue necrosis that foster the infection.

PHASE 5: HEALING PHASE 1: ONSET At D1 and D2, lesions of the primary DNA strands and cells triggers the release of free radicals.

PHASE 2: PRIMARY RESPONSE From D3 to D10, following cellular alterations and the

From D15 to D21, progressive restoration of local tissues.

1

- Pharmacology & Homeopathic Materia Medica, CEDH.

SEPTEMBER 2016 CEDH MAGAZINE

THE RADIOTHERAPY OR CHEMOTHERAPY INDUCED ORAL MUCOSITIS PROGRESSES IN 5 SUCCESSIVE PHASES.

release of free radicals, the release of pro-inflammatory cytokines induces local inflammation and cell apoptosis.

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Chemotherapy-induced oral mucositis CLINICAL INDICATIONS CLINICAL QUOTATION HAS 5 GRADES (NCI-CTCAE V3.0 / RTOG) GRADE 0: normal mucosa.

GRADE 1: mild. Painless ulcers, erythema, or mild soreness in the absence of lesions.

GRADE 2: Moderate pain with erythema, edema, or ulcers; eating or swallowing possible but disrupted.

GRADE 3: diffuse erythema, confluent ulcerations or pseudo membranes. The pain is intense. Unable to feed or hydrate properly.

GRADE 4: diffuse erythema, tissue necrosis. Pain is intense. Aphagia. Life-threatening consequences.

GRADE 5: Death.

In accordance with the toxicology of boric acid, its indication will be limited to a superficial lesion of the mucous membranes (grade 1), especially in predisposed patients.

PHYTOLACCA DECANDRA

TOXICOLOGY Besides skin inflammation effects, we will bring up the proportion of leucocytes, cardiac affections, oral, esophageal, gastric burns, vomiting, non-stop bloody diarrhea, embolism, and kidney affections, etc…

MATERIA MEDICA

Relevance of homeopathy in the treatment of chemo radiation oral mucositis

2

A. ORAL MUCOSITIS DURING THE INFLAMMATORY PHASE This phase corresponds to the immediate toxicity of radiotherapy or chemotherapy. Thus, it cannot be avoided. We will only give the corresponding medicines if the patient reports painful symptoms with the characteristic symptoms of the medicine.

BORAX

SEPTEMBER 2016 CEDH MAGAZINE

CLINICAL INDICATIONS Similarly to Borax, the toxicology and use of the medicine promote its use in the early stages (GRADE 1), especially when the tonsil pillars have red stripes and the pain shoots towards the ears (characteristic symptom).

B. ORAL MUCOSITIS DURING THE BEGINNING OF THE ULCERATIVE STAGE NITRICUM ACIDUM

TOXICOLOGY

TOXICOLOGY OF BORIC ACID

ACUTE EFFECTS

Boric acid is not highly corrosive, but it is irritating for the mucous membranes. The exposure to this substance can trigger gastrointestinal symptoms with vomiting and greenish-like diarrhea and then skin erythema and possibly liver toxicity and nephrotoxicity.

• EYES: triggers chemical burns. May lead to blindness.

• SKIN: triggers chemical burns. Ulcerations • INGESTION: Toxic if ingested. May trigger chemical burns of the mouth, throat and stomach.

• INHALING: can cause an irritation of the upper respiratory tract.

MATERIA MEDICA

20

• Burning pain at the root of the tongue radiating towards the ears.

• Aggravation when swallowing hot liquids.

• Local redness of the oral mucosa.

• Metallic taste.

• Canker sores, Aphthous stomatitis • Oral candidiasis • Cold sores • Diarrhea • Leucorrhea (egg white) • Dizziness aggravated by downwards movements.

• Nervous terrain with hyperesthesia.

• Complementary of Natrum muriaticum.

CHRONIC EFFECTS • Prolonged or repeated exposure can cause dryness of the mucous membranes, chapping and dermatitis.

• These two last symptoms correspond to chronic intoxication and should not be taken into account.

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Chemotherapy-induced oral mucositis MATERIA MEDICA • Canker sores on a bloody base, bleeding at the slighted contact.

• Splinter-like pain.

• Angular cheilitis.

• Hemorrhagic inflammation of the rectum and colon.

• Anal fissures.

CLINICAL INDICATIONS Angular cheilitis and ulcerations of the mucous membranes with splinter-like pain (GRADE 2) correspond to certain patients.

Anal fissures and digestive hemorrhaging are part of the chronic toxicology of nitric acid and correspond either to predisposed patients or to patients undergoing prolonged chemotherapy.

RHUS TOXICODENDRON

TOXICOLOGY The slightest contact with poison ivy is enough to trigger a toxic rash. Its latex has Cardol or Toxicodendrol and minimal quantities can trigger subcutaneous pustules. Its leaves, better known as poison oak, are used in the USA as erythema ointments.

MATERIA MEDICA • Vesicles eruption, dark red around the lesions.

• Dry and painful tongue with a red triangle at the tip.

• Sensation of pruritic burning pain aggravated by cold.

• Metallic taste in the mouth.

CLINICAL INDICATIONS Here again, this medicine corresponds to GRADE 2 oral mucositis. Ulcerations are bordered with an inflammatory red area. The pain is burning hot. The red triangle at the tip of the tongue can be seen in predisposed patients.

Hypersalivation, metallic taste, stomatitis Abdominal pain, diarrhea, vomiting, hepatic affections (cytolysis), cutaneous and mucous lesions (pruritic erythema, scarlet-fever like), neurological disorders that can linger for some times after the toxic exposure (headaches, tremors, sensory, motor and cognitive disruptions, personality disorders, confusion and sometimes coma with seizures) as well as moderate kidney tubule affection.

MATERIA MEDICA Common symptoms: sticky, thick saliva, white coated tongue, keeps the imprints of the teeth, fetid breath, and intense thirst.

MERCURIUS SOLUBILIS Foul-smelling, sticky sweats, aggravation of the symptoms at night, metallic taste in the mouth.

MERCURIUS CORROSIVUS Fetid breath and intense thirst.

Tenesmus, burning pain (hot coals).

MERCURIUS CYANATUS Alteration of the general state, prostration, canker sores with grayish, sticky and thick false membranes.

CLINICAL INDICATIONS Mercurius solubilis corresponds to a medicine of chronic toxic poisoning and infection. Mercurius corrosivus is similar but with a quicker onset and a more acute severity.

We will then prefer Mercurius solubilis when faced with a predisposed sensitive type or when there is an evolution towards infection. Mercurius corrosivus corresponds to GRADE 2 or 3 oral mucositis in its most common type. Mercurius cyanatus will be for the patient with a consequent alteration of the general state associated with the usual supportive care therapeutics.

■ MERCURY SALTS

■ MEDICINES OF SEVERE INFECTIONS

TOXICOLOGY

At this stage (GRADES 3 and 4) we are not restricted only to the acute toxicity of the medicine, but are confronted to an evolution towards necrosis and

Just the inhalation of highly concentrated mercury salts’ fumes triggers a cohort of

SEPTEMBER 2016 CEDH MAGAZINE

C. CLINICAL INFECTION TOWARDS INFECTION

symptoms very similar to those of chemo radiation oral mucositis.

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PRACTICE

Chemotherapy-induced oral mucositis general infection. This can be due to a predisposed sensitive type, or alteration of the general state related to the cancer or its treatment. The indicated medicines will be chosen according to the patient’s symptoms based on the Materia Medica and always associated with the usual supportive care therapeutics.

Besides Mercurius solubilis and Mercurius cyanatus that were already covered, we can think of the following medicines.

cramps, shock, coma, abnormal bleeding, and fever. Damages to the liver and acute kidney failure.

MATERIA MEDICA • Round, sharp canker sores, “cookie cutter” shape, with sticky mucus at the bottom.

• Heartburn.

• Ulcerations of the gastric mucosa.

CLINICAL INDICATIONS CARBOLICUM ACIDUM • Severe fetid breath, ulceronecrotic stomatitis, severe canker sores, fetid stools • Septic state with alteration of the general state, weakness, sudden circulatory shock. Facial paleness.

ELAPS CORALLINUS • Irritation of the nasal and pharyngeal mucous membranes.

• Fetid secretions.

BAPTISIA TINCTORIA • Ulceronecrotic pharynx. Bleeding, fetid and sticky pharyngeal mucus.

The corrosive nature of this acute toxicity matches perfectly the necrotic tendency of the chemo radiation oral mucositis.

The depth of the canker sore with clear borders described in the Materia Medical illustrates this necrotic side.

■ MEDICINES OF SEVERE NECROSIS Just like in severe infections we are faced with GRADE 3 and 4 oral mucositis. Thus we can apply the same thinking process regarding the implication of the patient’s terrain.

The indicated medicines will be chosen according to the patient’s symptoms based on the Materia Medica and always associated with the usual supportive care therapeutics.

D. PROGRESSION TOWARDS NECROSIS BISMUTHUM KALI BICHROMICUM

TOXICOLOGY

SEPTEMBER 2016 CEDH MAGAZINE

A. INHALATION Corrosive. Extremely destructive for the mucous membranes tissues and the upper respiratory tract.

Symptoms can include: • Sore throat • Cough • Short breath High exposure can cause pulmonary edema.

22

• Ulceromembranous stomatitis.

• Gangrene of the soft palate.

CONDURANGO • Ulcerated fissures of the corners of the mouth.

• Angular cheilitis was reported in case of esophageal or gastric cancer.

KREOSOTUM

B. INGESTION Corrosive. Ingestion can cause severe burns of the mouth, throat and stomach, eventually leading to death. It can also cause throat pain, vomiting and diarrhea.

• Inflammations of the mucous membranes with bleeding.

• Ulceration of the mucous membranes.

It can also lead to violent gastroenteritis, peripheral vascular collapse, dizziness, intense thirst, muscle

Inflammation of the mucous membranes with an ulcerative and bleeding tendency

SULPHURICUM ACIDUM

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PRACTICE

Chemotherapy-induced oral mucositis D. ARSENICUM ALBUM & PHOSPHORUS: THE ESSENTIAL MEDICINES ARSENICUM ALBUM

TOXICOLOGY 1. DISTRIBUTION Once absorbed, strong binding to the plasmatic proteins and hemoglobin.

Distributes in all the organs, mainly: • liver • kidney • lungs • muscles • skin, nails and hair • bones With age inorganic arsenic accumulates in tissues.

2. ACUTE TOXICOLOGY: GASTROINTESTINAL DISORDERS • Nausea, vomiting, gastrointestinal hemorrhages, abdominal pain “rice water”, “cholera-like” arsenic poisoning, which could be fatal.

• Hemodynamic imbalance evidenced by sinus tachycardia.

3. IN THE DAYS AND WEEKS THAT FOLLOW • Peripheral neuropathy, • Neuropsychological disorders, • Lesions of the skin, hair and nails.

4. CHRONIC TOXICOLOGY EFFECTS ON THE SKIN AND MUCOUS MEMBRANES (PREDOMINANT EFFECTS) • Hyperkeratosis of the palms of the hands and sole of the feet, concomitant to hyperpigmentation.

• Rhinitis, laryngitis, gingivitis, stomatitis and perforation of the nasal septum can also be observed.

EFFECTS ON THE CARDIOVASCULAR SYSTEM • Raynaud’s disease.

• Cardiac conduction and repolarization disorders.

• Alteration of the general state, rapid weight loss.

• Multiple food intolerance: food past their expiration date, ice cream, frozen food….

CLINICAL INDICATIONS Acute toxicology, the Materia Medica and the clinical experience point to a very important medicine. Its acute toxicology guides us towards a predominant affection of the mucous membranes.

PHOSPHORUS

TOXICOLOGY Absorption of white phosphorus after oral exposure – After 15 minutes: blood and liver (5% of the dose) – After 2-3 h: • Liver (65-70 %) • Blood (12 %) • Kidney (4 %) • Spleen (0.4 %) • Pancreas (0.4 %) • Brain (0.4 %) Total absorption corresponds to 82-87% of the ingested dose.

ACUTE TOXICITY • hepatic system: perilobular steatosis, cirrhosis; • cardiac function; • kidney functions; • neurological system.

Without going any further into the well-defined toxicology of Phosphorus, we observe an acute toxic affection affecting the major organs.

MATERIA MEDICA • Nausea.

• Reflex vomiting and by gastritis.

• Vomit when drinking.

• Vomiting blood, or vomit striated with blood.

• Stomatitis, esophagitis, gastric pain > when drinking cold liquids.

• Sensation of gastric emptiness.

• Hypersensitivity to smells.

• Perception of imaginary odors.

• Salty or metallic taste in the mouth.

• Jaundice, hepatitis, toxic hepatitis.

JUNE 2016 CEDH MAGAZINE

MATERIA MEDICA

ULCERATIONS THEN NECROSIS OF THE MUCOUS MEMBRANES • Secretions with a cadaver-like odor, nausea, vomiting.

• Burning digestive pain.

• Diarrhea with great weakness.

• Improvement by heat, by cold foods and drinks.

• Improvement by changing position.

• Aggravation at 1 am.

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Chemotherapy-induced oral mucositis CLINICAL INDICATIONS Acute toxicology and our clinical experience make phosphorus the second major medicine for supportive care during chemotherapy along with Arsenicum album.

Its multiple indications, based on the Materia Medica, make it an essential medicine for the supportive care of cancer patient.

3

To sum up and in conclusion Borax Phytolacca decandra Nitricum acidum Rhus toxicodendron

Acute inflammation Beginning of the ulceration

Mercurius corrosivus Mercurius solubilis Mercurius cyanatus Carbolicum acidum

Evolution towards infection

Elaps corallinus

THE FOLLOWING MEDICINES are much more important. They correspond to the reciprocal aggravation process of the necrosis and infection. The “leader” medicines: Mercurius corrosivus and Kali bichromicum are frequently used before the more advanced stages of infection or necrosis. They can be prescribed in prevention and will then be started at the same time as the beginning of the chemotherapy.

Arsenicum album and Phosphorus will complete the prescription in the context of chemotherapy with a more toxic action on the mucous membranes or major organs.

The patient’s sensitive medicine can be prescribed if the patients is predisposed to certain expected or observed side effects.

It can also guide the choice of the preventive symptomatic medicines prescribed.

For example, we will prefer Mercurius corrosivus or even Mercurius solubilis in a Silicea patient predisposed to infections, and Kali bichromicum in a patient with the Phosphorus sensitive type predisposed to necrosis.

Baptisia tinctoria Kali bichromicum

■ AN EXAMPLE OF A PREVENTIVE PRESCRIPTION

Bismuthum

FOR ORAL MUCOSITIS COULD INCLUDE:

Condurango

Evolution towards necrosis

Kreosotum Sulphuricum acidum Arsenicum album Phosphorus

The two essential medicines

JUNE 2016 CEDH MAGAZINE

Borax and Phytolacca decandra will be prescribed on demand when faced with telltale symptoms to lessen the pain. They correspond to an inflammation stage that cannot be avoided. It is an integrant part of the inflammation related to the action of the cancer drug.

24

Nitricum acidum and Rhus toxicodendron are indicated for ulcerations that are just starting. Their action timespan is very brief. Their corresponding affection of the mucous membrane is either going to heal quickly or progress to the other stages not accessible to these medicines.

THESE FIRST MEDICINES are then prescribed to the patient to be taken during the next course of chemotherapy if the same symptoms come back.

1. A GREAT TOXIC: • Phosphorus, • Arsenicum album, • Mercurius solubilis, • Causticum… ; 2. ONE OR TWO SYMPTOMATIC MEDICINES: • Mercurius corrosivus, • Kali bichromicum; 3. THE SENSITIVE TYPE MEDICINE if the patient is predisposed to certain expected or observed side effects. ■

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Care management of

EVERY DAY

PRACTICE

Juvenile Rheumatoid Arthritis (JRA) BASED ON 4 CLINICAL CASES

Antoine Demonceaux, Primary care Physician, Homeopath and Psychoanalyst, Reims, France.

T

his pathology, beginning in children before the age of 16, groups different types of joint pain with unknown etiologies. It excludes cases of specific diseases with infectious or oncology-related inflammatory arthritis. The prevalence is around 0.3 to 3 children per 1,000 in France. The diagnosis is

essentially a clinical one and has been defined in 2001 by a consensus of experts during an international conference in Edmonton, Canada. It is the most common of all chronic pediatrics affections. There are numerous clinical types, with varying degrees of severity, going from monoarthritis to clinical polyarthritis.

1

The diagnosis is essentially a clinical one TO DATE SIX TYPES ARE RECOGNIZED:

Different genetic studies show that these are different diseases with separate clinical presentations yet stemming from the same affection.

Different etiologies have been brought up: infectious and emotional ones, post-vaccine reactions.

These treatments often have a limited effectiveness and trigger several adverse side effects.

The main risks are joint deterioration, uveitis that can become severe because it is often asymptomatic, and affections of the heart and lungs.

Telltale symptoms are essential, because in this pathology, the earlier the management, the better the outcome.

SEPTEMBER 2016 CEDH MAGAZINE

• Systemic-Onset Juvenile Idiopathic Arthritis (Still’s disease); • Oligoarthritis type juvenile idiopathic arthritis; • Polyarthritis with the rheumatoid factor; • Polyarthritis without the rheumatoid factor; • Enthesitis with arthritis (spondylarthropathies); • Psoriatic arthritis.

The conventional medical treatment is based on different therapeutics such as: Nonsteroidal anti-inflammatory drugs (NSAIDs), steroid injections, Methotrexate® with its potential carcinogenic effects, and more recently antibody therapies (anti-TNF-alpha, Interleukin-1 receptor antagonist, Interleuking-6 monoclonal antibodies).

25

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Juvenile Rheumatoid Arthritis LOOK FOR: • any motor impairments in the child; • mood changes due to pain; • limping, refusing to walk; • frequent crying at night associated with other symptoms; • inflammatory fever (oscillating and occurring often in the evening).

• Pain was improved by immobility, applying pressure with a compression bandage and local heat.

• She is very tired and is aggravated at night.

Weight loss with a feeble appetite.

• Constipated with stools like marbles or large and painful.

• We note that she is always very thirsty.

Systematic biological lab tests bear no diagnostic value. It has been recognized that positive rheumatoid factors may have a prognostic relevance.

During the interview we discuss with the mother about the possible implication of several measles immunization shots.

The therapeutic care management is a multidisciplinary one: physiotherapy, orthopedics, psychotherapy and…homeopathy.

Homeopathy management will be based on the clinical results and will not take into account the nosology of the disease. Of course, homeopathy will not be systematically prescribed as a stand-alone treatment; a conventional treatment can be used according to the prognosis and patient’s complaint. The patient is the only one that really matters!

We will see that the terrain treatment is quite relevant, and review important symptomatic medicines.

CASE N° 1

SEPTEMBER 2016 CEDH MAGAZINE

■ JULIE, AGE 2, her disease started 6 months earlier.

She is seen at the Necker Hospital in Paris, France.

Her arthritis was diagnosed following an inflammatory fever that lasted several days, associated with joint pain, edema and functional impairment. Right away, she was affected in both knees and the right wrist.

Her rheumatoid factors were positive.

26

SHE WAS VERY DISABLED BY THE ARTHRITIS; she could barely walk and had severe nighttime pain.

TREATMENT: Methotrexate® and several steroid injections. NSAIDs had no effects.

Her parents brought her to the consultation because of the persisting pain and functional impairment.

THE CLINICAL ANALYSIS SHOWED THAT: • Three joints were affected, swollen and very inflammatory

■ PROPOSED TREATMENT • In the morning Bryonia 9 CH, 5 pellets as a symptomatic medicine associating the type of pain, constipation and thirst.

• In the evening Arsenicum album 9 CH, 5 pellets based on the notion of being improved by heat, nighttime aggravation and inflammatory syndrome with fatigue.

• On Sundays, we alternate - 10 pellets of Morbillinum 15 CH (isotherapeutic of the measles vaccine) - and Arsenicum album 15 CH as a terrain medicine.

The use of Arsenicum album in 9 CH and 15 CH is justified because we ask of these two dilutions to perform two different actions (local and terrain).

A month later, Julie is doing better, but the pain is still there.

■ THE TREATMENT IS MODIFIED BY • replacing Bryonia 9 CH with Bryonia 30 CH. • Arsenicum album 15 CH is prescribed weekly.

Bryonia 30 CH seems to yield very good results when dealing with a very sensitive patient with intense pain and when the expected outcome of the treatment is not satisfactory. This comment is valid for all pain and inflammatory medicines.

Julie improved quickly and has been well for 10 years.

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With this case study, homeopathy shows its relevance in a pathology where no real satisfactory treatments are available in conventional practice.

“ CASE N° 2 ■ 18-MONTH-OLD CLAIRE is brought to my consultation for monoarthritis of the right knee, which is swollen and painful. She has a hard time walking with a knee flexum of the right leg. Nighttime pain is moderate, but she still wakes up every night. Conventional treatment consists in NSAIDs, which are not very effective and steroid injections are becoming a possible option.

THE CLINICAL ANALYSIS REVEALS: • A personal history of frequent bronchiolitis and rhinopharyngitis episodes; • Edema associated with pain sensibly improved by cold; • A thin and cold-sensitive child; • Multiple adenopathies, especially cervical ones; • Little appetite with a normal digestion.

• Apis mellifica is continued and the terrain treatment is completed with Aviaire 15 CH and Sulphur iodatum 15 CH in addition to Silicea and Natrum muriaticum.

Sustainable improvement after four years of follow-up.

CASE N° 3 ■ 26-MONTH-OLD SOPHIE is seen in consultation. For the past 6 months she has been complaining of pain in her left knee and right wrist. She has a slight functional impairment with moderate gait discomfort.

The pain seems to alternate from one joint to the next.

According to the mom, it seems that it started right after her parents separated.

THE CLINICAL ANALYSIS REVEALS: • History of several recurrent rhinopharyngitis and bronchitis episodes with a slight persisting productive cough; • Moderate, erratic pain with no particular modalities; • Normal appetite and digestion; • No sleep disorders; • Non-specific morphology; • Child very attached to her mother, emotional who cries easily.

SEPTEMBER 2016 CEDH MAGAZINE

■ PROPOSED TREATMENT The homeopathic treatment proposed is simple: • Apis mellifica 15 CH, 5 pellets in the morning and in the evening based on the notion of edema and pain improved by cold.

• Silicea 15 CH and Natrum muriaticum 15 CH, 10 pellets alternated every other week as a terrain treatment (cold-sensitive, adenopathies, weight loss).

“

After a month of treatment, the improvement is significant. She had two rhinitis episodes associated with a dry cough.

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Juvenile Rheumatoid Arthritis ■ PROPOSED TREATMENT • Pulsatilla 15 CH, 5 pellets in the morning based on the notion of moderate, erratic pain and an emotionally, dependent child.

• Ignatia amara 15 CH, 5 pellets in the evening.

The child is very emotional.

• Sulphur iodatum 15 CH and Aviaire 15 CH on the notion of a Psoric-Tuberculinic Chronic Reactional Mode, marked by recurrent ENT and pulmonary episodes.

Sustainable improvement without the need of other therapeutics.

CASE N° 4 ■ PAUL IS 4-YEARS-OLD. For the past two years, he has developed arthritis in the right elbow, right wrist and left knee. Treated by NSAIDs and two steroid injections, with no noticeable improvement, faced with a risk of uveitis, Methotrexate® is being considered.

THE CLINICAL ANALYSIS SHOWS:

SEPTEMBER 2016 CEDH MAGAZINE

• Family history (father) of seasonal hay fever and psoriasis; • Personal history of skin disorders labeled as “eczema”, but its location (external side of the elbow, neck and inside of the thighs) is more consistent with psoriasis. Topical steroid treatment; • Normal appetite but frequently bloated; • Child with a temper and rarely ill; • Pain with no specific movement modality and improved by heat. The pain seems aggravated by fatigue and at the end of the afternoon.

• The etiology could be repeated immunization shots within a short period of time.

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■ PROPOSED TREATMENT • Lycopodium clavatum 9 CH, 5 pellets in the morning based on the history of skin and digestive disorders.

• Arsenicum album 9 CH, 5 pellets in the evening as symptoms improve with heat.

• Arsenicum album 15 CH and Sulphur 15 CH, 10 pellets every other week, based on the patient’s Chronic Reactional Mode. Using Arsenicum album in 9 CH and 15 CH is justified because we ask these two dilutions to perform two different actions (local and terrain).

The improvement is sustainable and the skin disorders did not come back.

2

Discussion Two chronic reactional modes seem preponderant: the Psoric and Psoric-Tuberculinic reactional modes. They have in common the periodicity and alternation of symptoms. The PT reactional mode will be characterized by a predominance of ENT and pulmonary affections and a great emotional sensitivity.

The Sycotic reaction mode, mainly concerning older children taking several prescription drugs, will be more rarely encountered. We could make an exception for small children with a PT reactional mode, who are often sick and infected, frequently treated with courses of antibiotics. In these cases Silicea will be the medicine of choice (Silicea belongs both to the PT and the Sycotic reactional modes).

Osteoarticular deterioration, which I have not encountered in my practice, will be characteristic of a Syphilitic-type affection.

Regarding the Psoric reactional mode, the alternation of skin and digestive disorders with periods of rest will have one saying that the child is rarely sick. We will frequently find Arsenicum album, Lycopodium clavatum and Bryonia in the acute state.

The Psoric-Tuberculinic mode characterized by its erratic pain, modulated by emotions on a terrain with an ENT weakness, will bring up Pulsatilla and its chronic complementary medicine Silicea. Natrum muriaticum goes well with Apis mellifica in the acute state (prone to edema). We will systematically add Aviaire when there are respiratory issues and Sulphur iodatum with an elective action on viral affections and adenopathies.

Priority will be given to the terrain treatment, which needs to be administered as early as possible to yield the best therapeutic outcomes. With this case study, homeopathy shows its relevance in a pathology where no real satisfactory treatments are available in conventional practice. Its impact on Public Health is once again validated. ■

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Therapeutic efficacy of Antimonium arsenicosum in the acute presentation of

EVERY DAY

PRACTICE

Obstructive pulmonary disease (OPD) in children Dr Ivan Nestorov, Sofia, Bulgaria

cute obstructive pulmonary disease (OPD) is a heterogeneous pathology with the

A

following key symptoms: Cough, nighttime cough / Respiratory distress / Wheezing / Tachypnea / Fluttering of the nostrils using accessory respiratory muscles / Sleep disorders and Effort intolerance.

The pathophysiology of these symptoms is well known: Muscle spasm / Edema of the mucous membrane and Hypersecretion. We need to underline that the younger the patient, the greater the role of hypersecretion and edema in the pathogenesis of OPD. OPD is seen in several common or rarer pediatric pathologies: acute bronchiolitis, asthma, foreign objects in the bronchi, etc.

Several studies report that OPD is becoming more common as an upper respiratory tract pediatric pathology. The socioeconomic impact of this syndrome is becoming a major issue.

WHAT TREATMENTS ARE AVAILABLE IN CONVENTIONAL MEDICINE?

A. GENERALITIES • Removing nasal secretions; • Be vigilant about nutrition and hydration, make sure they are adapted to the child’s age; • Proper home ventilation, elevating the child’s head when sleeping.

• Clearance of secretions; • Passive and slow expiratory technique; • Provoked cough.

C. MEDICINES • MUCOLYTIC – fluidifying agents – no study has

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B. RESPIRATORY PHYSIOTHERAPY

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29-32Nestorov US36_essai JAN 09 31/10/16 18:41 Page30

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Efficacy of Antimonium arsenicosum in Obstructive Pulmonary Disease (OPD) in children evaluated the effectiveness of N- acetylcysteine and carbocysteine in acute OPD. However, they have adverse side effects, including uncontrolled bronchial hypersecretion and according to the different countries their use is either banned or not recommended.

LOCATION: Pediatric medical center, private

• BRONCHIAL DILATOR INHALERS / ß-2 adrenergic agonists with a short-term action can be tried if they bring some improvement1. Recent studies validated a partial improvement on the short term, but without modifying the number of episodes, duration of the hospital stay and natural progression of the disease. The older the child, the more obvious the effectiveness of this medicine.

PROTOCOL

practice, Sofia, Bulgaria.

PERIOD: 2007-2015.

EVALUATION AT DAY 0 AND DAY 3 • Severity was quantified by the adapted Silverman RDS score.

• The medicine was chosen based on the principle of similitude and prescribed according to the pathophysiological approach.

• STEROIDS – their efficacy in OPD management remains to be discussed according to the etiology of the syndrome.

During an acute bronchiolitis episode, the systematic prescription of steroids was not validated by the French Expert Consensus Conference or the American Academy of Pediatrics.

The effectiveness of steroids on the viral load remains debated, and they have a negative effect on neutrophils

PLACE OF HOMEOPATHY Relevance of Antimonium arsenicosum

1 SEPTEMBER 2016 CEDH MAGAZINE

MATERIAL AND METHOD

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Clinical, observational, retrospective study based on 647 patients with OPD, evaluation criteria: • sex – boys, girls • age – 3- 12 months; 1-3 years; 3-7 years; 7-11 years; 11-18 years • OPD severity – Silverman RDS Score • OPD nosology – bronchiolitis in the first year of life; phenotypes A/ occasional obstructive bronchitis /; phenotypes B /bronchial asthma/; Neither A nor B phenotypes /intermittent wheezing/ 1

American Academy of Pediatrics

■ TREATMENT: • At D0, 5 pellets of Antimonium arsenicosum 15 CH every 3 hours, space out the takes according to improvement.

Of course, in case of therapeutic failure at D3 (evaluated with the Silverman RDS score), one needs to reassess the treatment, homeopathic medicines, bronchial dilator inhalers, steroids, oxygen therapy, hospitalization, etc.

INCLUSION CRITERIA All acute OPD cases, clinically validated, regardless of: • Sex • The episode or evolution stage • Etiology or nosology • Long term treatment – conventional or homeopathic

EXCLUSION CRITERIA • Children who received steroids, bronchial dilator inhaler or any acute/symptomatic medicine at the time of the consultation (i.e. D0) • Newborns 0-3 months • Children with severe respiratory distress – Silverman RDS score > 3 • Of course in the last two cases the patients need to be hospitalized.

29-32Nestorov US36_essai JAN 09 31/10/16 18:41 Page31

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Efficacy of Antimonium arsenicosum in Obstructive Pulmonary Disease (OPD) in children Clinical improvement according to sex at Day-3

Total Nr of clinical cases = 647

350

Male

Total number of cases 288

300

Female

45 %

359

250

223

200

Number of cases with improvement 202

150

55 %

100

62%

70%

50 0

Boys

Girls

Clinical improvement according to age at Day-3

Clinical cases by age ranges 3-12 months

9% 12 %

18 %

70%

250

1-3 years

60%

3-7 years 7-11 years

200 50% 150

11-18 years

40% 30%

100

22 %

Total number of cases Number of cases with improvement % of cases with improvement

20%

39 %

50

10%

0

0%

3-12 months 1-3 years 3-7 years 7-11 years 11-18 years

Clinical improvement according to severity at Day-3

Clinical cases divided by severity according to theSilverman RDS score

400

0-1 point

26 %

12 %

70%

350

1-2 points

300

2-3 points

250

60% 50% 40% 30%

150

62 %

100

20%

50

10%

0

0%

0-1 point

1-2 points

2-3 points

% of cases with improvement

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200

Total number of cases Number of cases with improvement

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29-32Nestorov US36_essai JAN 09 31/10/16 18:41 Page32

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Efficacy of Antimonium arsenicosum in Obstructive Pulmonary Disease (OPD) in children Clinical cases according to nosology

22 %

14 %

Clinical improvement according to nosology at Day-3

Infants’ bronchiolitis Phenotype A

300

Phenotype B

250

Phenotype non A non B

200

16 %

80%

350

70%

60% 50% 40%

150

48 %

30%

100

20%

50

10%

0

0% Bronchiolitis Phenotype A Phenotype B

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DISCUSSION & CONCLUSION

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• Results showed that Antimonium arsenicosum improves the course of acute OPD in children • The medicine is effective and acts quickly in the first 24-48 hours • By managing acute OPD as early on as possible, we can decrease acute complications, as well as negative consequences on the long term.

• The younger the child, the higher the clinical efficacy of the homeopathic medicine • It is thus a very good alternative, even as first line treatment in newborns and toddlers.

• It is also quite relevant to use it as a “sentinel” medicine once a day in prevention.

• To determine the dilution and frequency of takes, the CEDH international prescription consensus should be applied. ■

Phenotype non A non B

« It is not important for the pathogenic picture of a medicine to be toxic or clinical, the essential is for the medicine to be CLINICALLY VALIDATED » Constantin Hering

Total number of cases Number of cases with improvement % of cases with improvement

33-35Derbel US36_essai JAN 09 31/10/16 18:43 Page33

PRACTITIONER’S

IMPROVEMENT

Polycystic ovary syndrome a homeopathic approach Hassen Derbel, MD Sfax, Tunisia

P

olycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age with a prevalence of approximately 7%.

Women with PCOS present with clinical and/or biochemical hyperandrogenism, oligomenorrhea or amenorrhea and polycystic ovaries

evidenced on ultrasound images. Moreover, women with PCOS frequently exhibit insulin resistance and obesity. The conventional therapeutic management for this pathology is a multidisciplinary one, it is unfortunately symptomatic and far from satisfactory.

The relevance of this work is to discuss the homeopathic approach and the terrain treatment of the person with PCOS.

1

Hormone: from physiology to dilution The hormone is the most biologically and clinically active substance. Its plasma concentration is infinitely small. The unit taken is nanogram per milliliter and picogram per milliliter for pituitary or hypothalamic neurohormones.

The polycystic ovary syndrome is a good example to evidence the hypersensitivity of certain organs to hormones.

2

Hormone dilutions The objective of prescribing hormone dilutions is to change the body’s sensitivity to its own endogenous hormones.

This prescription has an impact on the sensitivity of the target cells in the hormone receptors.

Let’s note that these cells are present almost everywhere in the body.

SEPTEMBER 2016 CEDH MAGAZINE

The hormone is a substance secreted by a gland, and with an action on the entire body since the hormone receptors are everywhere in the target cells.

In the first part of this article we analyze hormone dilutions and in the second part we will bring up the different types of sensitive types.

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PRACTITIONER’S

IMPROVEMENT

Polycystic ovary syndrome: a homeopathic approach Given that the prescription of a low 5 CH dilution has a hypersensitive effect and thus a “hormone-like” result, high dilutions, 15 CH or 30 CH present a hyposensitive effect. The mean 9 CH dilution has a “regulating” effect.

TESTOSTÉRONE ACÉTATE • Hypersensitivity to testosterone • Ovarian hyperandrogenism (ovarian granulosa cells).

• Hyperandrogenism semiology: acne, hirsutism, aggressiveness, dominance, muscle cramps…

• Aggravation due to hyperinsulinism ■ Testosterone acetate 9, 15 and 30 CH.

LH (LUTEINISING HORMONE) • Painful and hemorrhaging ovulation • Hypertonic LH secretion seems to result from an alteration of the hormonal regulation negative feedback, probably secondary to the action of excessive androgens on the hypothalamic–pituitary–adrenal axis.

■ LH 5 CH Delayed ovulation peak with lengthening of the follicular phase.

■ LH 15 CH or 30 CH Very painful, hemorrhaging ovulation, spotting. .

DHEA-S • It is the main adrenal androgen.

• Its effect is supposed to be a gonad antiandrogen.

• Improve the sensitivity of endogenous DHEA. • Semiology: hypercortisolism, obesity in the upper body, facial brown spots, depressive mood, early aging.

■ DHA-S 5 CH.

INSULINUM • Insulin resistance.

• Metabolic syndrome with insulin resistance is frequently seen in women with PCOS (60 to 70%).

■ Insulinum 5 CH could be indicated to improve the sensitive of the target cells to endogenous insulin.

FSH (FOLLICLE STIMULATING HORMONE)

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• Follicular phase • During PCOS, the absence of an intercyclic FSH rise induces an absence of ovulation and thus the absence of luteolysis.

The presence of FSH inhibitors, such as the AntiMüllerian hormone (AMH) is a determinant of “follicular arrest”.

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■ FSH 5 CH • Improves follicular sensitivity to endogenous FSH. • Semiology: delayed ovulation, or cycles with no ovulation, hot flashes, small ovules with a size < 18mm in the pre-ovulating phase.

■ FSH 9, 15 or 30 CH In case of biological FSH rise, early menopause, decreased AMH…

3

Terrain of polycystic ovaries According to our experience during these past four years with patients affected by PCOS, the main sensitive types used as terrain treatments are: • Platina, • Kali carbonicum, • Moschus, • Lachesis mutus, • Lycopodium clavatum, • Aurum metallicum, • Calcarea phosphorica

PLATINA • Haughty, high self-esteem, despise and hate for others • Bipolar mood • Alternation of physical and mental disorders • Premenstrual syndrome, endometriosis • Hyperesthesia of genital area/ Vaginismus.

MOSCHUS • Gland secretion of the musk deer • Global nervous excitement with hypersensitivity • Neurotic structure / hysteria / conversion crisis

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PRACTITIONER’S

IMPROVEMENT

Polycystic ovary syndrome: a homeopathic approach

Polycystic Ovary

Normal Ovary • Localized contractures of the smooth muscles • Theatrical fainting, with sexual excitement.

• Amenorrhea • Ovarian dystrophy • Low ovarian reserve (low AMH).

KALI CARBONICUM • Metrorrhagia • Lumbar irradiation of pain • General anxiety disorders / fatigue • Heart failure, gastric hernia, renal failure, knee arthrosis • Organic cyst.

LACHESIS MUTUS • Premenstrual syndrome • Aggravation by late or absent menses • Alternation agitation / mutism • Vascular signs: hemorrhage / clots.

LYCOPODIUM CLAVATUM

AURUM METALLICUM • Major depressive tendencies • Violent anger

• Phosphoric constitution • Sport activities • Acne • Spaniomenorrhea • Usually young patients, athletes or professional sports players

4

Conclusion PCOS is quite a complex pathology. Pathophysiological mechanisms have yet to be elucidated. The clinical impact of this pathology is quite severe, with several systems being affected, gynecological, metabolic, dermatological and psycho-behavioral.

The homeopathic approach is very interesting and seems quite promising in light of the deep action of sensitive type medicine, and the use of hormone dilutions according to the pathophysiological mechanisms described. ■

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• Metabolic hepatic syndrome • High (LDL) cholesterol due to ovarian weakness • Early metabolic disorders • Late menses.

CALCAREA PHOSPHORICA

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