CEDH Magazine - JANUARY 2017 - NUMBER 43

THERAPEUTIC FILES

Every day Practice

Every day Practice

Asthma

Methodological tool to help the prescription in primary care practice

ENT clinical case

Materia Medica Causticum, from the patient’s individual reaction (PIR) to the sensitive type

Clinical Theme Deeper than skin deep

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 • J A N U A RY 2 0 1 7 • N U M B E R 4 3

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SUMMARY

CEDH magazine 3 EDITORIAL ,

Yves Lévêque, MD, 03

43 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 : Larry Baskind, MD Géraldine Mellin, MD Josette Nouguez, MD Laurence Saintier, MD Martine Tassone-Saillard, MD Production : Atelier Chalopin, Sérigraphie Editing : Élodie Ther Translator : Bénédicte Clement Illustrations : Fotolia Printing : ISSN : 1950-8832 Legal mention : 0516 T 88691 Publication date : January 2017.

4 THERAPEUTIC FILES ASTHMA Martine Tassone-Saillard, MD, 04

8 EVERYDAY PRACTICE

Methodological tool to help the prescription in primary care practice Rhinitis episodes in pediatrics Géraldine Mellin, MD, 8 13 EVERYDAY PRACTICE

ENT clinical case Laurence Saintier, MD, 13 19 MATERIA MEDICA

Causticum, from the patient’s individual reaction (PIR) to the sensitive type Josette Nouguez, MD, 19 22 CLINICAL THEME

Deeper than skin deep

JANUARY 2017 CEDH MAGAZINE

Larry Baskind , MD, 22

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EDITORIAL

Transmission Yves Lévêque, MD Editor in Chief

T

he issue 41 of the CEDH Magazine highlighted a CEDH school in full development, the following one insisted on the importance on the CEDH family, now we are focusing on transmission with:

- Topics covering asthma and rhinitis prescription in pediatrics; - Clinical cases focused on ENT; - The level of Materia Medica knowledge required through the medicine Causticum; - The international vision of skin disorders as presented by a US physician its role and how it is the mirror image of one’s health.

With the prescription consensus, Dr. Jacques Jouanny recognizes the essential criteria of the CEDH: simplicity, effectiveness and easy to implement in practice. He wrote these words to our attention:

‘‘

… present homeopathy as it is, a therapeutic among others, with its indications, limits and not a philosophy or esoteric sect”

”You are in the right mindset of the original CEDH vision: clarity, transmission, discarding esoteric drifts, priority to the clinical and pathophysiology.

I thought it would please you to hear it by the last survivor of the four original CEDH founders.

Congratulations! Continue on this difficult, yet incredibly exciting pathway to present homeopathy as it is, a therapeutic among others, with its indications, limits and not a philosophy or esoteric sect” JANUARY 2017 CEDH MAGAZINE

Thank you Dr. Jouanny for underlining the foundation of our values and trust us with their transmission. ■

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THERAPEUTIC

FILE

Asthma Dr Martine Tassone-Saillard, Salon-de-Provence

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Medicines for the acute episode

EDEMA MEDICINE

MEDICINES FOR SPASM AND INFLAMMATION

MEDICINES FOR MUCUS HYPERSECRETION

APIS MELLIFICA for its action on edema of the mucous membranes present in asthma pathologies.

BRYONIA essential for its anti-inflammatory action related to the presence of Leukotriene in the “Wild Turnip”.

ARSENICUM ALBUM agitated, anxious patient, crisis around 1 to 3 am, oppression, moderate catarrh but intense dyspnea.

CUPRUM METALLICUM coughing fits, improved by drinking cold water.

LACHESIS MUTUS suffocation with congestion, intolerance to tight clothes, need for air, aggravation in the morning, in the evening at bedtime, during premenstrual periods and menopause.

DROSERA dyspnea with dry and croup-like coughing fits that can lead to temporary cyanosis of the face, aggravated while talking, laughing at night around midnight and when lying down.

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SAMBUCUS NIGRA

4

hoarse cough with nasal obstruction, nighttime aggravation around midnight, when lying down, improved when sitting up.

ARALIA RACEMOSA expiratory dyspnea with wheezing crackles when lying down or after the first sleep around 11pm.

IPECA fine, wheezing, disseminated crackles, dyspnea and emetic cough, nauseous state, clean tongue and hypersialorrhea.

BLATTA ORIENTALIS major bronchial congestion, wheezing crackles, difficult expectoration.

ANTIMONIUM TARTARICUM difficult and noisy breathing, thick and abundant mucus, white-coated tongue.

KALIUM CARBONICUM tired, cold-sensitive patient, acute episode between 2 and 4 am, patient is improved when sitting down, difficult grayish expectoration.

SENEGA bronchorrhea with sneezing, dyspnea, oppression, aggravated when lying down, feeling of diplopia, with visual disturbances.

ETHYL SULFUR DICHLORATUM emetic coughing fits, with retrosternal burning, profuse mucus expectoration, cyanosis of the lips, fluttering of the nostrils. This medicine is indicated in asthma attacks in addition to

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THERAPEUTIC

FILE

Asthma allopathic treatments when awaiting emergency medical help. However, it seems interesting to give it to individuals, especially the ones sensitive to atmospheric pollution. They can use it at that time, right from the first respiratory symptoms or when the air pollution alert is announced.

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Etiology medicine ACONITUM NAPELLUS

following dry cold, strong wind, sudden fears.

DULCAMARA following damp cold, rainy weather, fog, getting cold after being wet or sweating.

■ Pulsatilla ■ Sulfur iodatum ■ Arsenicum iodatum WHEN THE ASTHMA HAS BEEN GOING ON FOR A LONG TIME, WITH SEVERAL TREATMENTS, THE SYCOTIC REACTIONAL MODE SHOULD BE CONSIDERED. ■ Natrum sulfuricum ■ Thuya occidentalis AND OF COURSE THE MEDICINES BELONGING TO THE TWO REACTIONAL MODES

■ SILICEA ■ CALCAREA CARBONICA OSTREARUM ■ SEPIA OFFICINALIS

OPIUM following intense fear with shock, after an anesthesia.

GELSEMIUM following affective emotional shocks, stage frights, anticipation anxiety.

Obviously this list is not comprehensive.

It is essential to take into account the sensitive types that have asthma in their pathological tendencies.

STAPHYSAGRIA following anger, indignation, suppressed sorrow, dwelling on vexations.

LUNG HISTAMINE

CLINICAL CASE

following allergies.

FOLLICULINUM following premenstrual syndrome.

3

Medicines of the chronic reactional mode The CRM at the forefront is the Psoric CRM but also the Psoric-Tuberculinic CRM.

■ Sulfur ■ Arsenicum album ■ Lycopodium clavatum ■ Natrum muriaticum

I SAW KATIA FIRST IN MARCH 1996, for her 10-year birthday.

She had asthma attacks almost every 15 days, especially in the winter, in spite of continuous treatment for years associating inhaled steroids, anti-histamines and Ventolin on demand.

Born at term 50 cm, 4.100 kg, Bacillus Calmette–Guérin (BCG) vaccine at the maternity, multiple immunization shots.

1.30 m, 38 kg.

FAMILY HISTORY an asthmatic aunt on the mother’s side. Father is allergic to pollens (hay fever).

PERSONAL HISTORY SURGICAL HISTORY: nothing to report.

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MEDICINES MOST OFTEN PRESCRIBED ARE:

FIRST CONSULTATION

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THERAPEUTIC

FILE

JANUARY 2017 CEDH MAGAZINE

Asthma

6

It is essential to take into account the sensitive types who have asthma in their pathological tendencies.

“

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Asthma MEDICAL HISTORY: recurrent rhinopharyngitis episodes.

Eczema. Allergy to cypress pollens, grass pollens, dust mites and cat hair.

DERMATOLOGICAL HISTORY: atopic skin, dry eczema behind the knees aggravated by going to the swimming pool and vexations, 2 plantar warts on the right foot.

DIGESTIVE: good appetite, soft stools every morning, overweight.

KATIA IS A GOOD, QUIET CHILD. She is an only child and is used to always be in the company of adults. She does not like to be alone, she can have sudden fits of anger.

She has some delay in her acquisitions, her teacher finds her too slow and she will repeat her last year of primary school.

She can doze off in class, at night she has a light sleep and wakes up at the slightest noise.

Cold-sensitive, she sweats easily from the head, and her extremities are often cold.

Her mother tells me that her asthma attacks occur generally at night between 2 and 4 am, especially when the wind is strong. Katia sits up in her bed, her cough is productive, with wheezes, she wants to throw up and she has a hard time expectorating.

improved quickly with Ventolin and the homeopathic treatment. She stopped the steroids and antihistamines over a one-month period. All has been well for two months.

SECOND PRESCRIPTION ■ I ask her to continue Lung histamine 15 CH every day, 5 pellets morning and evening, ■ Apis mellifica 15 CH 5 pellets morning and evening and ■ Calcarea carbonica ostrearum 15 CH 1 dose every Sunday for 3 months, with the same treatment in case of asthma attacks.

FOLLOW-UP I regularly followed Katia, adapting her treatment along the years. By monitoring the evolution of her respiratory capacity by performing peak-flows in my medical office or Respiratory Functional Explorations (RFE) at the pneumologist.

Today she is 30, I see her once or twice a year, she tells me that she is “addicted” to Lung histamine and Calcarea carbonica ostrearum. ■

FIRST PRESCRIPTION ■ Thuya occidentalis15 CH 1 dose each Sunday ■ Lung histamine 15 CH 5 pellets morning and evening ■ Apis mellifica 15 CH 5 pellets morning and evening ■ Calcarea carbonica ostrearum 15 CH 5 pellets in the morning ■ As soon as the weather turns windy Aconitum napellus 15 CH 1 dose ■ In case of asthma attacks: Ipeca 9 CH Blatta orientalis 9 CH and Kalium carbonicum 9 CH 5 pellets every half-hour, to be spaced out according to improvement.

TREATMENT FOR 3 MONTHS.

SECOND CONSULTATION Katia comes back again in July 1996. She is doing better, she had two asthma attacks in April that

JANUARY 2017 CEDH MAGAZINE

I advise the mother to continue the allopathic treatment and progressively space out the takes when Katia gets better.

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Methodological tool to help EVERY DAY

PRACTICE

The prescription in primary care practice RHINITIS EPISODES IN PEDIATRICS Dr GĂŠraldine Mellin, NoumĂŠa

F

aced with the frequency of consultations for rhinitis, especially in pediatrics, I tried to organize the different homeopathic medicines available to save time during the interview. I position them on a chronological timeline (much like a historical timeline) going from T-1 (what appears before the patient comes to

the consultation) up to T+ x according to the duration of the symptoms.

1

T-1 or what happens before the consultation These symptoms are not observed during the examination but can give an indication on the etiology.

When the patient presents with the same consequences following the same triggering factors, these medicines could be prescribed in anticipation of the next episodes.

Here is the list (not comprehensive and stemming from my clinical practice) of rhinitis etiologies.

FOLLOWING EXPOSURE TO DRY COLD JANUARY 2017 CEDH MAGAZINE

NUX VOMICA

8

HEPAR SULFUR Hypersensitive to cold, pain => nasal obstruction

FOLLOWING EXPOSURE TO DAMP COLD DULCAMARA Exposure to damp cold followed by nasal obstruction, clearing up pharyngeal mucus secretions

ALLIUM CEPA Sneezes aggravated by heat with irritating laryngeal tickling triggering a cough, sometimes a hoarse one.

MERCURIUS SOLUBILIS Corrosive watery rhinitis, major sneezing fits

Air drafts => shivers, nose stuffed-up at night, sneezing fits, intermittent clear, irritable behavior

ACONITUM NAPELLUS Getting cold => violent sneezing fits, starting at night around midnight, nasal obstruction followed by a clear discharge +/- fever

TEETHING CHAMOMILLA VULGARIS Hypersensitivity to pain, irritability, improvement when being held and rocked

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Methodological tool to help the prescription in primary care practice MERCURIUS SOLUBILIS Watery rhinitis that can become tinted, mercury tongue, irritating excessive salivation

2

T 0: The time of the consultation

MERCURIUS SOLUBILIS Corrosive with numerous sneezing fits, pharyngeal redness with dysphagia, mercury tongue, dry cough aggravated at night with chills and sweats

ARUM TRIPHYLLUM Hoarseness and excoriation of the lips ■ PROFUSE

AT THE BEGINNING OF THE RHINITIS STAGE, SYMPTOMS HAVE BEEN PROGRESSING FOR LESS THAN 3 DAYS EDEMA APIS MELLIFICA Sensation of stuffed nose, improved by fresh air +/fever with no thirst

INFLAMMATION: from the less inflamed state to the most inflamed one

• not very irritating

KALIUM IODATUM Slightly irritating but with frontal pain, constrictive pain at the root of the nose, sneezing fits.

• Irritating

ALLIUM CEPA Improved by cold

FERRUM PHOSPHORICUM Variability and alternation, sub-feverish syndrome, alternation of redness and paleness, clear rhinitis +/ear pain, nose bleed, dry cough

BELLADONNA Based on characteristic fever

ACONITUM NAPELLUS Rarely seen at this stage of the consultation

AT THE STAGE OF THE DISCHARGE: SYMPTOMS HAVE BEEN PROGRESSING FOR AT LEAST 8-10 DAYS

TINTED DISCHARGE • Non irritating

HYDRASTIS CANADENSIS Yellow discharge, sticking in the cavum, possible dry cough when lying down

PULSATILLA Flowing discharge during the day but not at night, productive cough during the day and dry at night, variable medicine in its symptoms

KALIUM SULFURICUM

WATERY

aggravation of Pulsatilla

■ NOT VERY PROFUSE

• Irritating

• Not irritating

NUX VOMICA Intermittent

Not very flowy, nose is mostly stuffed up • Irritating

ARSENICUM ALBUM Very irritating, burning improved by heat + AEG

+/- irritating, crackling in the ears, foul odor of old cheese, painful hoarse cough

KALIUM IODATUM Alternates from yellow to green, can progress to frontal sinusitis

KALIUM BICHROMICUM Plug with nasal crusts and punctiform pain, sometimes a trickle of blood posterior clearing throat at the end of the night

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DULCAMARA

HEPAR SULFURIS CALCAREUM

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Methodological tool to help the prescription in primary care practice

The same medicines can thus endorse several roles: symptomatic medicine in the acute phase, or CRM medicine in the chronic phase or sensitive type medicine

“

“

TINTED: PROFUSE DISCHARGE, FROM THE LESS IRRITATING TO THE MOST IRRITATING

MERCURIUS SOLUBILIS Mercury tongue, impact on the general stage, adenopathies

PULSATILLA Variable in the symptoms and in its efficacy, not very reliable

T + 1: it lingers…the discharge has been lasting for more than 10 days

3

KALIUM SULFURICUM The mineral of Pulsatilla, more reliable in its effectiveness, tinted from yellow to green

SULFUR IODATUM Increased fatigue, small adenopathies

HEPAR SULFURIS CALCAREUM

WHITE ASPECT OF THE MUCUS SECRETION

The most aggravated of the series, foul-smelling secretions

KALIUM MURIATICUM

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Thick, not very abundant, not very irritating, catarrh cough and seromucous otitis (hypoacusis)

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SOMETIMES

KALIUM SULFURICUM Transparent discharge with a faint streak of yellow and cough when swallowing mucus

4

ALL THESE MEDICINES CAN TREAT ACUTE RHINITIS EPISODES

T+2 : complications AT THE NEXT STAGE, WE SEE TWO POSSIBILITIES:

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Methodological tool to help the prescription in primary care practice IT GETS COMPLICATED and we will have at our disposal

THUYA OCCIDENTALIS

the medicines for otitis, sinusitis, sore throat and bronchitis. It will then be interesting to know if this is a unique episode or if, during each rhinitis episode, the patients presents with the same complications, in order to always anticipate the next prescription

Medicine of Sycosis, not very common in pediatrics, will be useful faced with recurrent courses of allopathic treatments

RECURRENT EPISODE OR NOT RESPONDING TO THE TREATMENT:

MEDORRHINUM More useful than Thuya occidentalis in pediatrics because of its associated antiinflammatory action

We will then look for the patient’s Chronic Reactional Mode (CRM), with always the same question: “when did it start, how does it evolve?”

WE WILL ALSO LOOK AT BIOTHERAPEUTICS,

WE WILL THEN FIND THE SYMPTOMATIC MEDICINES AND

AVIAIRE

THE CLINICAL PICTURE WILL HELP US CHOOSE THEM

Key medicine of recurrent ENT infections especially in pediatrics

NATRUM MURIATICUM Albumin-like, daily, every morning

PULSATILLA Yellow, non-irritating, discontinued

SULFUR IODATUM

WHICH WILL HAVE AN ACTION ON THE ASSOCIATED IMMUNE SYSTEM MODULATION:

TUBERCULINUM For ENT infections associated with bronchitis, tracheitis, in an asthenic agitated child, often tired and who catches a cold easily with a short periodicity, loses weight in spite of a retained appetite, hypersensitive and irritable when sick.

More irritating, small adenopathies

MEDORRHINUM SILICEA In between the Psoric-Tuberculinic reactional mode and the Sycotic reactional mode: lingering suppuration

Corresponds to the Sycotic reactional mode with again an inflammatory part, infections linger, chronic catarrh.

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Methodological tool to help the prescription in primary care practice THIS MEDICINE is usually adapted to the chronic reactional mode and will be prescribed once a week in doses.

Furthermore, it will be useful at this stage to look for a medicine of the sensitive type in order to restore the child’s balance.

” ”

Since WHEN have you had these symptoms ?

FOR ACUTE SYMPTOMS, I would only choose symptomatic medicines according to the description of the discharge and the patient’s individual reaction, with frequent takes and spacing them out according to clinical improvement.

JANUARY 2017 CEDH MAGAZINE

FOR LINGERING OR RECURRENT SYMPTOMS,

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The same medicines can thus endorse several roles: symptomatic medicine in the acute phase, or CRM medicine in the chronic phase or sensitive type medicine

which is often the case in pediatrics when children are in daycare or kindergarten, I do not waste time looking for the symptomatic, I go directly to the CRM medicines, biotherapeutics or sensitive type medicines.

CLASSIFY THESE MEDICINES ON A CHRONOLOGICAL TIMELINE

THE RISK OF RECURRENCE IS DECREASED. THEN, ACCORDING TO THE CASE I CAN ADD

helps me go directly to the useful stage with one single question:

ONE OR TWO SYMPTOMATIC MEDICINES IF NEEDED. ■

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ENT clinical case Dr Laurence Saintier, Belmont d'Azergues

ENT

CLINICAL CASES BERNARD, AGE 83 For several years, Bernard has been presenting with chronic, thick yellowish rhinorrhea with anosmia, ageusia and expectoration similar to the rhinorrhea.

This was happening almost on a daily basis.

Between September and December 2015, three episodes of acute sinusitis with severe pain required three courses of steroids and antibiotics.

I then suggested to Bernard a homeopathic treatment at the beginning of January 2016.

FAMILY HISTORY none

PERSONAL HISTORY • Transurethral resection of the prostate (adenoma) • High blood pressure • Appendectomy • Esophageal mycosis • Gastric ulcer at the age of 25

• No pulmonary disorders, gets vaccinated every year for the flu.

• His high blood pressure no longer requires treatment (previously treated with ACE inhibitors).

He complains of recent dizziness with loss of balance.

• Diverticular disease (involving the sigmoid colon); prone to constipation; only eats once a day at lunch.

• Quite cold-sensitive, does not sweat.

• For several years Bernard took benzodiazepines to sleep. He is no longer taking them, he goes to sleep at 10:30 pm and wakes up at 6 am, takes out his dog for a walk and gets back to sleep until 10 am. He still feels quite tired during the day, would gladly take a nap in his armchair and is getting slower.

• Depressed since his wife died 18 years ago, he took several antidepressants, but did not take them regularly.

• He suffers from memory loss.

• At times, he confesses to experiencing “dark thoughts”.

THE CLINICAL EXAMINATION did not yield any specifics, Bernard is tall and lanky.

GENERAL INTERVIEW AND EXAMINATION ADDITIONAL EXAMINATIONS: • LAB RESULTS: Hypercholesterolemia • He had two sinus CT scans, which validated the chronic maxillary sinusitis.

• Bernard went to an ENT specialist: no surgical indication: Treatment with mucolytics and sulfur.

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During his episodes of sinusitis, pain is localized in the maxillaries with eye watering, headaches, mucopurulent rhinorrhea. Aggravation by cold and dampness.

• No dermatological disorders.

• Beginning of age-related macular degeneration (AMD).

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PRACTICE

ENT clinical case PRESCRIPTION ■ Kalium bichromicum 9 CH, 5 pellets morning and evening ■ Baryta carbonica 9 CH, 5 pellets in the morning ■ Phosphorus 15 CH, 5 pellets in the evening ■ Silicea 15 CH, 1 dose each Wednesday ■ Medorrhinum 15 CH, 1 dose each Sunday

and by foggy weather.

• She says that at first her nose gets stuffedup with the sensation of severe congestion • Then she sneezes and the discharge becomes yellowish.

• Finally, the nose gets stuffed up again, she then clears up her throat continuously from mucus that seems to stick to the bottom of her throat.

TREATMENT FOR 3 MONTH I gave him an additional prescription should Bernard present with the beginning of acute sinusitis.

■ Hepar sulfur calcareum in escalating doses Take a dose in 9 CH on the 1st day then a dose in 15 CH on the 2nd day then a dose in 30 CH on the 3rd day.

■ Mezereum 9 CH, 5 pellets 4 to 6 times per day according to the pain, to be spaced out according to improvement (to be taken right from the 1st day).

I renewed Bernard’s chronic treatment twice. He did not need to use the treatment for acute episode as he did not have any recurrent sinusitis episodes.

Rhinorrhea and expectorations remain very occasional and Bernard no longer suffers from dizziness.

DIGESTIVE • Good appetite without gaining weight • Normal transit DERMATOLOGY After falling from a bicycle she presented with a wound that suppurated for a long time before healing.

BEHAVIORAL TENDENCIES: • Calls herself nervous, very stubborn, hypersensitive “to everything”, is always worried about her professional abilities.

• Sleep: she has a medium sleep especially if she is tired or if she works “too much”.

• Cold-sensitive, yet sweats a lot • Is easily tired • She believes she wore herself out to finish her geography doctorate and she “no longer has any immunity”

CLINICAL EXAMINATION: FABIENNE, AGE 33 comes to the consultation for a treatment because at the beginning of winter she presents with rhinitis occurring every three weeks on average.

FAMILY HISTORY MOTHER: Bronchial dilatation FATHER: High blood pressure

• Young, thin woman with small bones • Big expressive eyes • Blood pressure: 10/6 • No rhinitis to date

WHAT DO YOU PROPOSE? Determining the medicines taking into account:

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PERSONAL HISTORY

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• Digestive disorders as a newborn • Otitis episodes as a child and iterative bronchitis episodes in adolescence • Recurrent sties

INTERVIEW ENT: multiple rhinitis episodes since she has been living in her grandmother’s house, close to a swamp

■ Etiology: Dulcamara ■ Inflammatory stage: Apis mellifica ■ Infectious state: none ■ Symptoms: in case of rhinitis, Dulcamara ■ CRM: Patient’s CRM Aviaire or Tuberculinum ■ Sensitive type: Silicea

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ENT clinical case

“

The choice of the dilutions will be based on the CEDH prescription consensus.

ESTELLE, AGE 12 is brought to the consultation for repeated asthma attacks.

“

PULMONARY Attacks essentially at night, most often after midnight • Respiratory distress, with wheezing, improved when she seats up on the side of the bed • Difficult expectoration with clear secretions

FAMILY HISTORY • Allergic rhinitis in the mother and younger brother • Eczema in the mother

DIGESTIVE • Prone to constipation • Very good appetite with no major weight gain

PERSONAL HISTORY

NEUROLOGY • Headaches as soon as she is tired

• Frequent rhinopharyngitis episodes • Recurrent rash • Common angular cheilitis lesions • Asthma since the age of 6

• Budesonide inhaler morning and evening • Salbutamol spray on demand

CLINICAL EXAMINATION

DURING THE INTERVIEW

• Tall and lanky child • Dry skin with some dry patches

DERMATOLOGY • Notion of skin eruptions with skin exposure

PULMONARY EXAMINATION diffuse, sibilant crackles in both lungs.

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ONGOING TREATMENT

BEHAVIORAL TENDENCIES • Moderately cold-sensitive • Quiet, serious and reserved child, yet sometimes very impulsive

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ENT clinical case ADDITIONAL EXAMINATION none

WHAT DO YOU PROPOSE? Determining the medicines taking into account: ■ Etiology: Lung histamine ■ Inflammatory stage: Bryonia ■ Infectious state: none ■ Symptoms: Kalium carbonicum ■ CRM: CRM of the patient (Silicea, Sulfur iodatum, Natrum muriaticum…)

■ Sensitive type: Natrum muriaticum

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The choice of the dilutions will be based on the CEDH prescription consensus. ■

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MATERIA

MEDICA

Causticum From the Patient’s Individual Reaction (PIR) to the sensitive type

Dr Josette Nouguez, Périgueux

C

austicum is a toxic substance prepared by Hahnemann from burned lime and potassium sulfate and only experimented in high dilutions, consequently Hahnemann recommended to only prescribe this medicine in high dilutions.

FOUR PATHOGENIC TARGETS WILL ATTRACT OUR ATTENTION: ■ THE CENTRAL AND PERIPHERAL NERVOUS SYSTEMS where it triggers: - local (e.g. vocal cords, sphincters) or generalized (limbs) paralysis and paresis, - dysesthesia with burning and numbing pain, all this associated with a sensation of general or localized physical and psychological weakness with tremors; ■ DIGESTIVE AND RESPIRATORY MUCOUS MEMBRANES with sensations of burning, scrape-like, tearing pain, especially when coughing; ■ THE OSTEOARTICULAR SYSTEM with stiffness, ankylosis or tendon retraction;

Etiologies are essential in Causticum.

• PHYSICAL SUFFERING OCCURRING EARLY ON: prenatal, neonatal or postnatal period. Along with neurological disorders leading to delayed psychomotor acquisitions (language, communication) and delayed walking, with a disharmonious gait.

• IT CAN OCCUR LATER ON after an affective separation, feeling of abandon (starting daycare, birth of a sibling, parents separating).

It is usually expressed via motor regressions (gait, joint stiffness), with neurological regression (sphincter paresis), psychological regression with loss of acquired skills (language, writing) and finally affective regression (ambivalence with behavioral reactions).

The reasons for consulting will be related to the pathogenic targets and we will cover here only the pathologies of the mucous membranes and pediatric behavioral disorders.

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■ SKIN with cutaneous lesions (warts, painful hypertrophic scars), dermatitis with fissures, as well as generalized or localized pruritus.

IN CHILDREN WE WILL ALWAYS FIND SOME SUFFERING.

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MATERIA

MEDICA

Causticum

1

At the level of the respiratory mucous membranes • LARYNGOTRACHEITIS with hoarse, painful cough with “tearing” pain, like a raw wound that tortures the entire body.

• HOARSENESS

URETHRAL SPHINCTER • Urinary incontinence: the patient is not aware of the flow of urine. Urinary incontinence during efforts (cough, sneezing), posttraumatic incontinence (surgery, catheterization).

• Its clinical indication will also be found in pediatric enuresis, but also in children who are often wetting themselves during the day: “she plays and waits until the last minute!”

• Urinary retention after bladder exertion and getting cold.

aggravated at dusk.

ANAL SPHINCTER

• VIRAL RESPIRATORY INFECTIONS in addition to the classic treatment, if the cough characteristics are present.

• COUGH unable to evacuate the major bronchial congestion (paresis) that can be associated with uncontrolled loss of urine during the coughing fits.

These pathologies are aggravated by dry cold and improved in a hot and humid atmosphere.

2

At the level of the digestive mucous membranes • BURNING GASTRIC PAIN like quicklime, improved by a sip of cold water.

• BURNING, POUNDING ANAL FISSURES

• Paretic constipation with frequent but useless needs to go to the stool. Voluminous stools that require intense efforts to be expelled and are associated with redness of the face. Generally, the patient has an easier time with the bowel movement if he is standing up.

• Encopresis, is another reason for consulting associated with sphincter paresis and distension of the rectum.

• Anal incontinence due to the loss of anal sensitivity.

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Causticum sensitive type in children To determine this sensitive type we must first find the etiologies and pathological targets of the medicine.

with intense itching night and day and prickling sensation in the rectum.

MORPHOLOGY

• BURNING, FIRE-LIKE HEMORRHOIDS

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which tend to infiltrate and harden.

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NEWBORN • often hypothrophic with a sweet, yet sad look, making him or her looking like a victim already.

At the neurological level

CHILDREN

we will retain the most important element, i.e. the sphincter paresis.

• small face, often with ears sticking out, with a thin body yet voluminous and soft abdomen contrasting with a very muscular thorax, quite surprising at that age.

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MATERIA

MEDICA

… we will note the importance of Causticum in physical and behavioral pathologies in children without neglecting its major relevance in aging.

© Fotolia

“

• The stiffness is very pronounced leading to walking difficulties and hard time participating in sports. The child walks on the tip of his toes, as if his “tendons were too short”.

• This stiff gait on tiptoes will continue for a long time.

BEHAVIOR

BABY often passive, sleepy, with an alternation of agitation, screams at the slightest change of schedule, meeting new people, going to new places.

CHILD

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Conclusion

At the end of this approach to Causticum we will note its importance in physical and behavioral pathologies in children without neglecting its major relevance in aging, theme that will be addressed in another article.

We will insist on the physical and psychological etiologies.

■ THE PATHOLOGICAL SYMPTOMS CAN BE SUMMED UP

BY THE FOLLOWING KEYWORDS:

FEARS, INSECURITY, PHYSICAL AND INTELLECTUAL REGRESSIONS, STIFNESS, ANKYLOSIS, SCLEROSIS, PARALYSIS, PARESIS.

JANUARY 2017 CEDH MAGAZINE

• Shy, sweet and helpful child; who becomes suddenly aggressive, contrary, even violent.

Bites, hits, kicks.

• If the child is upset he freezes up, shuts himself from the word and is unable to hear logical reasoning.

• Strong mood swings switching quickly from the kindest gesture to the most despicable aggressiveness.

• The child is also very anxious, always afraid from himself but mostly for his friends and family.

• Very attentive to the needs of others, he is always very compassionate towards his young friends and pets.

• His utmost desire is “I WANT TO HELP”.

• He cries a lot. He cries for everything and everyone, he often has emotional tears, he reacts very quickly.

“

• Starting school will be a difficult moment where Causticum will be prescribed for the child’s depression.

The child takes a long time to adapt to the school system, but is a very quick learner regarding schoolrelated acquisitions, he can however regress at the slightest stress.

• Going to sleep will be a difficult moment because the child is afraid of the dark and is anxious about going to bed (sleeping is a rupture!).

• His sleep is filled with nightmares and night terrors • His sleep is also marked with primary or secondary enuresis. It often appears after psychological trauma that might have gone unnoticed because they seemed quite trivial.

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CLINICAL

THEME

Deeper than skin deep Presentation by Dr Larry Baskind made at the 5th International CEDH Conference in Chicago Adapted for the CEDH magazine by Dr Yves Lévêque

I

t is the largest organ in the body, each average adult has about 6 sq. meter of skin. Both with its function and aspect, it can give us a lot of information on the person in front of us. We already understand that we will be able to obtain information to determine symptomatic and chronic treatments.

CAN THE SKIN LEAD US TO THE ROOT OF THE PROBLEM? The comprehensive analysis of elementary lesions is essential to determine a medicine according to the aspect, stage, localization or anatomopathophysiological similitude.

The original characteristics of the patient’s individual reaction (sensations, modalities and concomitant signs) should also be considered and it is important and mandatory to use a modern Materia Medica as all the information must be reliable, verifiable and validated.

It is essential to remember that faced with the anatomo-pathophysiological symptoms, the importance of the patient’s individual reaction fades away.

It can offer a comprehensive care management different from classic treatments, taking into account the specificities of each individual, in order to determine the patient’s sensitive type and chronic reactional mode.

It can bring a therapeutic answer to treatment limits often encountered in skin disorders.

Let us look at atopic dermatitis to illustrate our presentation

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Atopic dermatitis ERYTHEMATOUS EDEMA STAGE APIS MELLIFICA

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is at the forefront but

1

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The place of homeopathy in dermatology

Homeopathy plays an important role in dermatology because of the absence of intolerance, adverse events or interactions with other medicines.

URTICA URENS will be the differential diagnosis most often encountered.

ERYTHEMATOUS STAGE BELLADONNA is most often indicated.

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CLINICAL

THEME

Deeper than skin deep VESICULAR STAGE

EXFOLIATION

RHUS TOXICODENDRON

THE MEDICINES MOST OFTEN FOUND ARE

with its vesicles filled with a yellowish liquid must be differentiated from

RHUS VERNIX

ARSENICUM ALBUM with two possible aspects: flour-like or furfuraceous;

presenting with clusters of vesicles.

BORAX shows a single vesicle with sometimes several rings around it.

ANAGALLIS ARVENSIS corresponds to several, clustered erythematousvesicular lesions with severe pruritus. The preferential localization to the hands and fingers are also quite characteristic.

ACROTON TIGLIUM is rarely seen because the vesicles rupture and release a corrosive liquid triggering a very intense pruritus, major sign validating the choice of this medicine.

CRUST STAGE

THE MEDICINES TO BE CONSIDERED ARE: GRAPHITES with its honey-like discharge;

PETROLEUM with “dirty” looking skin;

MEZEREUM bringing up an impetigo-like lesion with brown crusts becoming darker along the progression of the disease;

MERCURIUS SOLUBILIS looking like an elementary Mezereum with more suppuration;

ANTIMONIUM CRUDUM corresponding to hyperkeratinization of the lesion;

with a crust resting on top of ulcerations with regular borders;

CALCAREA SULFURICA with yellowish small crusts validating the presence of Sulfur in the name of the medicine.

corresponding to very small flakes, about 1 sq. millimeter in size;

NATRUM SULFURICUM for lesions with a shiny, “wet” looking dermis, and large yellowish flakes;

KALIUM ARSENICOSUM prescribed for dry and flaky lesions that can bring up Arsenicum album or Arsenicum iodatum but, in the case of Kalium arsenicosum, pruritus is aggravated by heat.

Fissures in the skin folds of the elbows and popliteal fossa can also be noted.

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For the chronic treatment ALL SENSITIVE TYPE MEDICINES SHOULD BE CONSIDERED Often we observed an increase of the pathological tendencies or behavioral signs.

The use of these medicines is essential to help the patient get back to a balanced state and sustain it.

THE MAIN MEDICINES OF THE CHRONIC REACTIONAL MODE (CRM) • PSORIC MEDICINES like Sulfur, Psorinum, Arsenicum album or Lycopodium clavatum should be considered.

• SOME MEDICINES OF THE

PSORIC-TUBERCULINIC CRM such as Natrum muriaticum, Tuberculinum, Pulsatilla, Sulfur iodatum, Calcarea phosphorica or Phosphorus are also often indicated when

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KALIUM BICHROMICUM

ARSENICUM IODATUM

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CLINICAL

THEME

Deeper than skin deep

We can see all the different homeopathic treatment possibilities in dermatology.

“ the specificities of this group add up to the Psoric characteristics.

“

The choice is made when elaborating the prescription according to the clinical data and is often encountered for Polychrests such as:

• MEDICINES OF THE SYCOTIC CRM such as Thuya occidentalis, Medorrhinum and Natrum sulfuricum should be considered if the pathology progresses on a chronic mode or if one or several etiologies of this reactional mode are present.

• MEDICINES LOCATED “IN BETWEEN” two reactional modes such as Calcarea carbonica ostrearum, Sepia officinalis and even Silicea are quite useful.

These medicines can help stabilize the treatments over time.

A POTENTIAL ISSUE IS DETERMINING THE PLACE OF A SPECIFIC MEDICINE

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DOES IT CONCERN:

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- A SYMPTOMATIC MEDICINE WITH SEVERAL TAKES A DAY? - A MEDICINE OF THE SENSITIVE TYPE? The prescription of 5 pellets in 15 or 30 CH per day at the beginning of the treatment followed by one dose per week to maintain the balance is the standard recommendation; - A MEDICINE OF THE CHRONIC REACTIONAL MODE with a prescription once a week in doses of 15 or 30 CH ?

- Sulfur; - Lycopodium clavatum; - Arsenicum album; - Natrum muriaticum; - Sulfur iodatum; - Calcarea carbonica ostrearum; - Sepia officinalis.

Using a medicine from this list in two different dilutions is possible because the medicine chosen plays two different roles in the prescription.

For example: chronic reactional mode and sensitive type or sensitive type and symptomatic medicine…

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In conclusion We can see all the different homeopathic treatment possibilities in dermatology.

Let us appreciate the precision of the therapeutic responses according to the aspect, stage, localization or anatomo-pathophysiological similitude.

In chronic cases one should consider the relevance of the sensitive type and chronic reactional mode.

We will then be able to really understand the “deeper than skin deep” concept. ■

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