Perspectives in Homoeopathic Treatment of Malaria
NATIONAL JOURNAL OF HOMOEOPATHY 1994 Sep / Oct Vol III No 5.
Ramayya N.
Research.

Malaria is a disease largely of the tropics, though it extends upto 60 degree North and 40 degree south of equator and thrives mostly at altitudes below 1500 metres above the sea level. It is known since ancient times, having been independently recognized in Ayurvedic and Unani medicines. It was also known to be infectious in origin. Malaria is caused by four protozoan species, Plasmodium-vivax, P-malariae, P-falciparum and P-ovale, the first being the most extensive in distribution. It is the female Anopheline mosquito which transmits the disease from the infected to the healthy persons. Amongst the infectious diseases, malaria claims the highest toll of human life. In 1950 the incidence at the global level was 250m and 2.5m deaths. Recognizing this colossal loss, WHO sponsored a program to control and eventually eradicate malaria from the globe through the use of insecticides to control the mosquito and mass treatment of the affected persons with chloroquinine phosphate and allied medicines to eradicate the infection. By 1960 the incidence came down to 100m and loss of life to 1m per year. But due to unexpected development of resistant strains to the biocides both in the mosquito as well as the Plasmodium especially Plasmodium falciparum, there is now a resurgence of malaria and it is so shaping that let alone eradication, even control of malaria is difficult and the disease poses an open challenge seeking alternative solutions. It is in this context that homoeopathy is relevant and the present study has been undertaken to explore what it could offer, both for cure as well as prophylaxis. This has necessitated a review of what has already been published on homoeopathic treatment of the disease. To this is added the information the writer has at hand from his clinic.

Clinical Reports:

The information collected from the past literature is summarized in Table 1. Four major sources containing consolidated information on clinical reports of malaria are those by - Temple and Hoyne (1879), Allen (1884), Clarke (1904) and Hughes. Amongst these, Allens work represents a monograph on intermittent fevers, the like of which has not been attempted so far. It is comprehensive, gives details of the case reports, describes all the known chill causing drugs besides inclusion of a repertory. He reports over 100 cases cured by 50 homoeopathic medicines based on a review of the then literature (TAble 1). Temple and Hoyne (1878) likewise deal with results of over 50 cases treated by about 25 drugs (Table 1) while Clarke (1904) lists out over 100 drugs clinically confirmed as curing intermittent fevers (Table 1). Hughes provides a masterly review of the principles of the treatment which seems to hold good even for todays situation of Homoeopathic treatment of malaria. The necessity of making periodical reviews of literature in homoeopathy has been forgotten over the last more than 80 years resulting in loss of continuity of knowledge and absence of upgradation of information, infact relating to any disease. Additional references have been made available of Deshpande (1973), Desai (1975), Kumta (1976) and Sehgal (1987) in Table 1.

The writer has so far handled over 30 cases wherein about 10 were disappointing failures to the patient who tenuously stuck to homoeopathic treatment but could not be helped. The details are given for convenience in Table 2.

The survey reveals about 200 well documented case reports treated by over 60 homoeopathic remedies besides recording over a hundred drugs producing malaria like syndrome in provings, giving an inkling into the vast armamentarium available to combat malaria through Homoeopathy. Five cases have been reported with pathological evidence of which four were of P Vivax and one of P Falciparum (Table 2). It is important to note that many of the cases were those which were relapses after allopathic treatment with quinine preparations or which did not respond to it even at the outset thus clearly pointing to the relative usefulness of homoeopathy.

1. Differential Diagnosis:

Flu and Urinary tract infection and even certain ailments can give rise to malaria-like syndrome. Hence in a stricter sense the term malaria, must be applied only when the presence of Plasmodium has been verified. As of today malaria senseu stricto is recognized in the following varieties depending on the associate Plasmodium species Macleod 1984 -

a) Malaria due to P Vivax and P Ovale:

The malady caused by these two organisms is identical. It represents the typical form of malaria characterized by the familiar three phases in the paroxysm.

1. Chill with rigor of 1/2 to 1 hour, associated with rise in temperature, dry and contracted physique, often with vomiting and severe headache.
2. Heat, burning in character upto 106 degree F or a fraction more; some patients passing into delirium lasting upto 1-6 hours.
3. Sweat (apyrexia) usually copious when the temperature shows steady decline reaching normal to subnormal levels, patient feeling normal, often falling asleep.

The paroxysms are on alternate days or tertian. The spleen and even the liver, especially in children become palpable and tender. In India P Vivax is the dominant infection.

b) Malaria due to P Malariae:

The malady is characterized by the three phase paroxysm as in the above but milder in intensity, quartan or occurring on every third day. In India it is restricted to Karnataka.

c) Malaria due to P Falciparum:

Here also the disease displays the three phase paroxysm but the heat phase is especially milder and the bout is quotidian or every day in occurrence. Jaundice is a common association due to hepatitis and haemolysis, the patient growing anaemic. Liver and spleen enlarge and become tender and palpable.

Though the delimitations given above seem definitive yet depending on the individual, variations are frequent in several features like abridgement of the paroxysm, by the absence of one or two of the phases, timing of the paroxysm, duration of the chill, thirst, gastrointestinal conditions, disturbances in the cerebro-spinal sensations all of which become significant in the individualization of the treatment. It should further be emphasized that preceding the paroxysms, the incubation period of malaria may be associated with several ancillary symptoms - the patient becoming wasted and cachetic depending on the potential lesions in ones defence.

Many cases as described by Allen (1884), Temple and Hoyne (1878) and Clarke (1904) do not in the strict sense conform to the above definitions and hence some of them may not really represent malaria.

2. Non Association of the Pathogen:

From a pathological view point, at times malaria is quite baffling. Often blood samples of the patients showing typical malarial syndrome even when collected during the expected chill rigor phase are without the Plasmodium. That the patient however is suffering from malaria is then confirmed by the drug to which the patient shows response. It is possible that there is a technical fault in the preparation of blood smear and its staining. But since this experience has been frequent, the writer wonders whether there does not occur a malaria-like syndrome without the pathogen but being caused by some unknown toxic agent. As far as homoeopaths are concerned, this situation is not difficult to conceive for provings of the many homoeopathic drugs resemble malaria syndrome though no pathogen is in the picture. Indeed the provings of malaria-officinalis provide testimony in this regard, where the substance involved is only a putrefied vegetable matter as of marshes. While it is too premature to conclude on the possibilities of the existence of non-infectious malaria it is worthwhile to keep the issue open for continued observation by practitioners in general whenever the opportunity offers for pathological verification.

3. Selection of Similimum:

Malaria generally presents a multifaceted expression, typically by the three phase paroxysm associated with auxiliary symptoms besides cachexia or background symptoms on becoming chronic. This is obviously due to the variety and definitive developmental stages through which the parasite passes in the human body - in exoerythrocyte (hypnozoite and merozoites) and the endoerythrocytic (merozoite, trophozoite and schizont) phases (Macleod 1986). Each of these stages could contribute its respective toxins, resulting in the typical paroxysmic phases and their concomitants. Consequently, selection of similimum has been problematic which continues even today. Hahnemann having himself been the first formal prover of quinine which led him to found homoeotherapeutics, was quite seized of the problem and proposed the following principles in the selection of the similimum.

1. The remedy should have in its provings the same sequential phases in paroxysm as in the disease syndromes.
2. Or the drug should correspond with the most peculiar of the three phases of the paroxysm including their ancillaries.
3. Should have similarity with the timing of paroxysm if it is highly specific.
4. Period of appearance whether quotidian, tertian or quartan is not to be given consideration.
5. If in the patient the cachexia is dominant (the so called Malaria intoxication - see Hughes page (252) in the background, whether in the prodromal or apyrexial phases these cachetic characters should be the primary guide. The cachexia becomes significant when the disease is chronic.

Hughes, Kanjilal (in Deshpande 1973) and probably many others have expressed themselves in favor of this approach. Kanjilal is more specific in stating that while recent malarial fevers respond to the peculiarities seen in the three phases of the paroxysm, the chronic ones require consideration of the cachetic symptoms besides those seen in the past history as well as the family history. He regards malaria to be of miasmatic origin. Being not only psoric in character but also sycotic as indicated by the enlargement of the liver and spleen and other varied hydrogenoid dyscrasic symptoms. Dr. Wurmb and Casper emphasize like Hahnemann, only the cachetic characters to be of significance. Further the similimum according to them should embrace the mentals as well as physical symptoms of the disease (see Hughes page 252).

There is a difference of opinion by some regarding the treatment in the case of non-chronic intermittents, from the chronic forms. Sircar preferred to treat with quinine, so also the experience in America in the last century (see Hughes page 254). Failure of malarial treatment had become so common in America that it was generally held that "Homoeopathic physicians cannot cure Ague" (see Hughes Page 254). But in England Bayer had total success in treating all his 75 case (Hughes page 252).

In the recent Indian experience the approach of Sehgal (1987) is especially relevant. He has treated patients all displaying mere mentals and accordingly he based the treatment only on them. It would be interesting if even in cases where usual paroxysm with their physical characters and concomitants are clearly expressed whether prescription based only on mentals would still yield results.

The writer considers that as yet firm and lasting principle for selecting the similimum have not emerged despite over 150 years of rich experience of homoeopathic treatment of malaria. Malaria like many other ailments in chronic state becomes metastatic, expressing itself in different forms in different parts of the body and in such cases the chill may be experienced in only certain body parts. To be more specific, what the writer visualizes is that malarial toxaemia essentially involves silencing of the oxidative mechanism in one or more parts of the body and this leads to sensation of chills in the parts concerned and finally their dysfunctioning due to non availability of the energy supplies, which has the potential to bring an end to the life of the host. Therefore such drugs which can review the oxidation in varied parts of the body would form the appropriate remedies. Apparently polychrests which can kindle oxidation would provide the answer to the question. In this regard Ars-alb, Calc-ars, Chininum etc. (as for example suggested by Hughes page 257 as remedies for malarial cachexia) and similar others might be appropriate in the case 19 (table 2) the author when failed to get results by giving Ars-alb prescribed Ars-hydrogen which since more deep acting (see Clarke 1904) helped in successful treatment. Thus in chronic cases such drugs could be effective than not only polychrests, high oxidants but also deep acting being able to penetrate remote parts of the body like the nerves, bones and various glands. A comprehensive picture of the problem thus seems related to our understanding of the physiological role of homoeo-drugs and this is possible when, as in other fields of science in homoeopathy, research with modern instruments is seriously sought after. Homoeopathy is so far only two dimensional having mastered the end products and the traits, but it has yet to acquire its depth, the third dimension through instrumental and chemical analysis to become fixed like a rock.

4. The Problem of Drug Resistance in Plasmodium Falciparum:

Resistance to drugs by infections and even the host is a common place phenomenon especially in such therapeutic systems where drugs are required to be consumed in substantial quantities. This phenomenon usually does not become a problem in homoeotherapy due to the high dilutions in which drugs are used though if frequently consumed certain degree of drug resistance is encountered here too. At any rate the resistance by the infection is not a welcome phenomenon and is a portend of negation of therapeutics itself. Amongst the malarial infections Plasmodium Falciparum is one which is currently found to show drug resistance in India and elsewhere and it could hence fast be widespread and cause greater loss of life. It is relevant to mention that P-vivax which is more common infection is found to be equally resistant. In modern medicine, maintenance doses after the treatment proper is over, are provided for some weeks, which is expected to make the patient immune to the infection. But in a good number of cases, let alone acquisition of immunity by the host, the latter itself crumbles under the weight of the iatrogenic effects resulting in more lesions in the defence. The homoeopathic literature currently reviewed however does not offer any instance of confirmed P Falciparum having been treated and hence cannot shed light on the problem. However the writers experience of treating in a single case of P Falciparum malaria (Table 2) is interesting in the sense the patient showed rapid response in the medication with Sulphur 200 and 1M and so far (i.e. over 3 months) there has been no relapse. Further this short experience also indicates that P Falciparum responds better to treatment than P Vivax. It is a welcome situation in so far as combating P Falciparum with homoeotherapy is concerned. However the treatment of many more cases is essential before any definite conclusion can be drawn in this regard.

TABLE 1

PARTICULARS OF CASE REPORTS FROM THE PAST LITERATURE

TEMPLE & HOYNE: Clinical Medicine

1. drugs supported with clinical cases
   
   Note : () represents the number of cases treated.
   
   Apis (4), Aranea (1) Arnica (2), Ars-alb (3), Cact (3), Calc (3), Camphor (1), Caps (2), China (1), Cina (2), Gels (3), Hell-nig (1), Ipecac (5), Lycopod (1), Merc-cor (1), Merc-cor (1), Natrum-mur (6), Nux-vom (4), Opium (1), Petrol (2), Puls (6), Rhus-tox (1), Sars (1), Sepia (1), Stram (1), Sul (1), Thuja (1).
   
   
2. Drugs without clinical cases:
   
   Aconite, Antim-crud, Antim-tart, Bell, Bryon, Cantharis, Caust, Cham, Chelid, Cocculus, Coff, Con, Dros, Ferr-met, Ignatia, Lach, Laur., Ledum, Nitric-ac, Nux-mos, Phos, Phos-ac, Silica, Spig, Staph, Verat-alb.

ALLEN 1884

Note: () represents the number of cases treated.

1. Drugs supported with Clinical cases:
   
   Aconite (3), Aesc (1), Antim-crud (2), Apis (4), Aranea (2), Arnica (4), Ars-alb (8), Baryta-c (1), Bell (1), Bry (3), chamo (1), China (3), China-sul (2), Cimex (1), Cina (1), Coff (1), Colch (1), Dros (many), Elat (4), Eup-perf (9), Eup-pur (3), Ferr-met (1), Gels (2), Ignat (6), Ipecac (5), Kali-carb (2), Lach (3), Lycopod (3), Menyan-mercurial (1), Nat-m (10), Nux-vom (3), Opium (2), Petrol (1), Plant (1), Podo (1), Puls (5), Rhus-tox (2), Sabad (2), Samb (2), Sepia (1), Stram (1), Sul (1), Thuja (1), Ver-alb (2).
   
   
2. Drugs Without Clinical cases:
   
   Aeth, Agaricus, Alst, Ambra, Ammon-mur, Anac, Angust, Antim-tart, Asaf, Bapt-tinc, Benzinum, Bovis, Cact, Calad, Camph, Cench, Carb-anim, Carb-ac, Cascar, Caust, Cedr, Chelid, Cicuta, Cocculus, Conium, Cor-flour, Croc, Cup-met, Curare, Cyclamen, Digit, Dulc, Elaps, Eucal, Euphorb, Gamb, Graph, Hep, Hydr, Hyosc, Iod, Kali-bich, Kali-br, Kali-carb, Mag-mur, Marum, Merc, Mezer, Natrum-sulph, Nitric-ac, Nux-mos, Paris, Petros, Phell, Phos-ac, Phos, Psorin, Robin, Sars, Sarrac, Secale, Silica, Spig, Stan-met, Staph, Tarax, Valer.

CLARKE: Dictionary of Materia Medica

The following drugs represents all those described by the author under Ague, Brow ague and intermittent fever. All of them are claimed to have been clinically confirmed:

Aesc, Angust, Antim-tart, Apis, Aranea, Ars-alb, Astacus, Azadi, Bry, Bufo, Cact, Calc-ars, Calc, Cench, Coff, Carb-veg, Car-bol-ac, Cardus-mar, Cascar, Caust, Ceanonth, Ced, Centaur, Chimaphi, chion, China-ars, Chin-mur, China-sulph, Cimic, Coff, Colch, Corn-alter, Corn-circ, Cor-flor, Elat, Eucal, Eupat-perf, Eupa-pur, Ferr-met, Ferr-phos, Gels, Gentiana-quin, Iris, Kali-bich, Lach, Lycop, Malaria-off, Menyan, Natrum-mur, Nux-mos, Nux-vom, Oleum-jecor, Ostreya, Petros, Phell, Plect, Plum-met, Polyp, Podo, Plant, Puls, Quas, Quer, Rhus-rad, Robin, Sabad, Sanic, Sars, Sinap-nig, Sulph, Sulph-ac, Tarax, Tarent-cub, Tarent-his, Urtica, Verat-alb, Verbena, Vichy.

DESAI 1975

Case 1 Graphites 200 (China, Sulph and Ars-alb given earlier failed.)
Case 2: Menyan 200 (China-sulph and Natrum-mur given earlier failed).

KUMTA 1976

Lactic-acid 30 (Ars-alb given earlier failed)

SEHGAL 1987

Case 1 - Hyoscyamus 30 (Hell, Opium, Stram, given earlier failed)
Case 2 - Psorin 210
Case 3 - Lil-tig 30
Case 4 - Stram 30

TABLE 3

DRUGS PROPOSED BY VARIOUS AUTHORS AS THE MOST EFFECTIVE IN

MALARIA:

Baehr

1969

1. Arnica

14.

Wurmb

(Hughes page 254)

Ars-alb

Puls

5. Role of Homoeopathy in the Cure and Prophylaxis of Malaria:

The present survey as mentioned in the introduction was taken up to find out if homoeotherapy could provide an alternate to fight malaria, since allopathic medicine is steadily recoiling on its own. The study brings to the fore as summarized earlier about 200 case reports of malaria cured by 60 drugs. Many more such reports are scattered in the literature. Even so one might feel surprised in how 150 years, why only such few case reports have come to be published. This is due to the fact that there are no higher centres of learning and researchers devote to homoeotherapy producing new knowledge like in other fields. Whatever information has to see light it should come from practising physician who would be hard pressed for time. However at this stage it is enough to mention that the available records though quite meagre are good enough to demonstrate that homoeopathy is effective in fighting malaria. It is also a fact that often failures are encountered and should such a fate befall, if homoeopathy is offered to deal with malaria on a mass scale, what would be the utility of this system? The failures reported are however insignificant and would have been due to resistant strains of the infection and hence would have needed treatment through appropriately deep acting drugs. But what has been painfully lacking is the needed R and D effort to improve the homoeotherapeutic strategies. The writer has earlier shown (Ramayya 1984) that about 85 percent of the people belong to the same constitution and that one or a few drugs would be needed to treat a given disease and also for prophylaxis in the case of a majority of the people. The medicine of a genus epidemicus is a success due to this identity of constitution of the majority of the people but it is glossed over because it contradicts the principle of individualization. Since these contradictory phenomena were not resolved by Hahnemann, homoeopaths out of great and truly justified veneration for the latter, would never be prepared to reconsider the controversy. Without any further wrangling over the issue it is enough to state here that homoeotherapy can offer safest medicines for cure and prophylaxis against malaria. In the light of their experience number of workers have come out with lists of most effective homoeopathic remedies against malaria which are given in Table 3. The writer to be objective has preferred to select only such remedies which have atleast in the literature been reported to have cured five or more cases. They are as follows:

1. Apis many
2. Arnica 6
3. Bryonia 14
4. Calc-carb 5
5. Drosera many
6. Eupatorium-perf 10
7. Gelsemium 7
8. Ignatia 6
9. Ipecac 10
10. Menyanthes many
11. Nux-v 7
12. Pulsatilla 7

The list proposed is not final, and indeed there could be additions and deletions in it in the light of more experience. But there should be no doubt that the drugs listed should be effective both in cure and prophylaxis, since they are clinically proven. It is interesting that quite a number of them are shared in common by the lists, others have proposed, which confirms their curative potential.

Experience shows that malarial parasites are much variable., what drug was effective few months back becoming inconsequential later. To understand the dynamics of these labile infections steady research is essential. It is high time that the centers of research are established in the different parts of the country to determine the regional needs of homoeopathic drugs to counteract the disease. Though individual physicians would treat their patients by their own acquired skills, this would not be adequate to devise treatment at the mass level.

Editor: This article is reprinted into as it is one of the most comprehensive articles on Malaria that if have read.

Prof. N RAMAYYA
Reprinted from The Homoeopathic
Heritage, March 1991.

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