An Approach to a patient with Anemia
NATIONAL JOURNAL OF HOMOEOPATHY 2001 Jul / Aug VOL III NO 4.
Dr Amtiava De Sarkar
'Chin / Carbo-veg / Phos-ac / Stron-c / Ferr-met / Phos / Ars-a / Crot-h / Calc-p / Cycl / Nat-m

In evaluating patients, the physician should proceed to diagnose anaemia correctly with minimum laboratory tests and procedures. The presence of symptoms related to anaemia depends on severity and more importantly, on rapidity of onset. In the latter, due to lack of adequate time for compensatory adjustment, the patient tends to have more marked symptoms, than in those of equivalent severity but developed insidiously¹

To evaluate the etiology, keep in mind the following three processes:

1. Haemorrhage either acute or chronic
2. Hypoplasia or aplasia or red cell production and
3. Haemolysis.

Blood loss below 100ml can be corrected by oral supplement of iron (in ferrous form) and protein. Among these, Carbo-veg, Chin, Phos-ac play a valuable role³. These drugs probably correct the hypovolumia by reducing the vascular bed by vasoconstriction. Stron-c is the drug for chronic sequalae of hemorrhage⁴

Iron Deficiency is by far the most common cause of anaemia worldwide. The possible factors are iron deficient diet, impaired absorption (mainly seen in peptic ulcer, mal-absorption syndrome), increased requirement (eg pregnancy) and loss of blood. Excessive menstruation (average loss 30 mg of iron in each month) and occult bleeding from the gastrointestinal tract (eg peptic ulcer, neoplasm, hookworm infestation, hemorrhoid, etc) are the causes of loss of blood⁵.

Iron is absorbed in duodenum in ferrous form, but can also be absorbed as haem-form from red meat. Much of the iron in food is un-absorbable because it is irreversibly bonded with phytate and phosphate, eg spinach has high quantity of iron but almost total is unabsorbable⁶. Red meat is a good source of iron. In rural area there is a belief that Kulekhara (Hindi-Tal-makhana) (Hygrophilia spinosa) is a good source of iron and used as hematinic. But studies show that the iron content is very much negligible⁷.

Other than food supplementation, synthetic iron compound like Ferrous-sulphate, Ferrous-fumerate, Ferrous-gluconate and Ferrous-succinate⁸ can be used in acute deficiency along with collateral homoeopathic treatment of the aetiological background (ie miasm). There is no reason to administer haematinic such as iron, vitamin B12 or folic acid unless there is a specific deficiency of these substances. In contrast, the inappropriate use of iron preparations over a prolonged period of time leads to a state of iron overload, which is harmful to body⁹.

Most authors claim Fer-met as the chief drug for anaemia. The indication for homoeopathic prescription should be the symptom-complex, that is, due to excess of iron intake in prolonged time 10 ie a picture of increased erythrocytosis, iron overload and iron toxicity. Dr Hahnemann in Materia Medica Pura in Fer-met chapter described the symptoms of the effect of iron on persons who habitually drink chalybeate waters; those are very similar to symptoms of high haematocrit.

Keep in mind that some symptoms of increased erythropoiesis is very similar to iron deficiency anaemia but the cause is totally opposite. Careful study of drug picture of Fer-met shows that there are signs and symptoms of iron deficiency anaemia, but these may be due to alternating action of drug. It should be the drug for polycythaemia and anaemia with iron overload only in high potency but we often use it in iron deficiency anaemia when symptomatology corresponds.

Readers are requested to go through the "Ferrum" chapter of Clarke's Dictionary of Practical Materia Medica and clinical features of polycythaemia from any textbook of Medicine. At the time of Dr Hahnemann the term polycythaemia was not known, and so this type of symptomatology was also classed as "anaemia"¹¹. It may also be the drug for chronic iron overload, eg hemosiderosis, haemolytic anaemia, thalassaemia with transfusional iron overload (isopathic use). The laws of Arndt-Schultz states that micro-doses of substances stimulate the physiological function but large doses depress it, supports this contention¹². So, what is the right answer? Further trial and Proving of Fer-met is needed to search out the real answer.

Megaloblastic Anaemia is caused either due to deficiency or impaired absorption of vitamin B12 and folic acid. Impaired absorption due to intrinsic factor secretion ceases owing to atrophy of the gastric mucosa, is termed as pernicious anaemia. Here features of vitamin B12 deficiencies are prominent along with features of anaemia. Current studies show that pernicious anaemia is an autoimmune disorder. The neurological manifestations are most worrisome and many times irreversible. It is due to degeneration of spinal cord featuring numbness and paresthesia in the extremities than weakness, ataxia, and poor finger coordination13, simulating the drug picture of Phosphorous¹⁴. In Boericke's Repertory Arsenic and Phosphorous both are in Italics15. However both are useful also in aplastic anaemia, which is discussed below.

Aplastic Anaemia happens due to severe hypoplasia (Miasmatically syphilitic in nature) of the erythroid, myeloid, thromopoietic cell lines in bone marrow leading to ecchymosis, petechiae or hameorrhage due to thrombocytopenia along with classical features of anaemia. Patient becomes susceptible to infection due to leucopenia. Chemicals, which can cause aplastic anaemia in toxic doses or prolonged use, are the drugs in potentised form¹². A number of cases of aplastic anaemia have been reported following infectious hepatitis¹⁹.

Phos is a very good drug in this condition as it causes fatty degeneration of blood vessels, bone marrow, atrophy of liver leading to petechiae, hemorrhage and hematogenous jaundice16. Aplastic anaemia is also from toxic effects of Arsenic, Chloramphenicol and Benzene and others^17,18. Besides Ars and Phos, Chloramphenicol and Benzene can be used in potentised form in aplastic anaemia, if totality corresponds.

Can irreversible condition of bone marrow be cured homoeopathically besides palliation? Management of aplastic anaemia has become one of the most challenging aspects of modern medicine¹⁹. It has already been proven that homoeopathic medicine can repair chromosomes even in the irreversible condition²⁰. So the homoeopathic drug can do better in aplastic anaemia besides supportive therapy of modern medicine. Clinical trials can confirm.

In Haemolytic Anaemia (also syphilitic in nature), red blood cells undergo premature destructions by intravascular or extravascular haemolysis. Haemolysis is seen in a variety of diseases likely thalassaemia, spur cell amenia, hereditary spherocytosis, certain infections (eg clostridium welchi) sickle cell anaemia, auto-immune haemolytic anaemia etc. Substances, which have hemolytic property in crude form, can be used in potentised form if symptomatology corresponds (eg Crot-h, Phos etc)

Most times, anaemia is secondary to chronic inflammatory disorders, as for example, rheumatoid arthritis, liver disorders, chronic infections, neoplastic disorders, regional enteritis, systemic lupus erythematous etc. anaemia may also be found in endocrine failure, uraemic syndrome. Treatment by Homoeopathy is not disease specific rather aetiology and stage specific, which Dr Hahnemann called miasm. Criteria for selection of homoeopathic drugs, depends upon symptom similarly in miasmatic background.

Apart from the above, there are many more drugs, which can manage anaemia, popular ones being Calc-p, Cyclamen, Puls, Nat-m, etc. However readers are requested to treat their cases miasmatically by single drug at a time 21 along with collateral management if needed.

References:

1. Harrison, Principle of Internal Medicine, 9th ed. Pp. 287
2. IBID, Pp. 269
3. W. Boericke, Pocket manual of Homoepathic Materia Medica, Pp 941
4. IBID, Pp613
5. Harrison, Principle of Internal Medicine, 9th ed. Pp 1515
6. Davidson, Principles and Practice of Medicine, 15th ed. Pp496
7. R N Chopra, S L Nayar, I C Chopra, Glossary of Indian Medicinal Plant 4th reprint ed. \, 1996 Pp28
8. Laurence, Bennet, Brown,Clinical Phramacology, 8th ed. Pp536
9. Harrison, Principle of Internal Medicine, 9th ed. Pp 271-272
10. Clarke, A dictionary of Practical Materia Medica Pp 754
11. IBID, Pp754
12. Linn, J. Boid, A study of Simili in Medicine, Boericke and tafel, Philadelhia, 1936, Pp 289-299.
13. Harrison, Principle of Internal Medicine, 9th ed. Pp 1521
14. Boericke, Homeopathic Materia Medica Pp510
15. IBID, Pp 953
16. IBID, Pp 507
17. Laurence, Clinical Pharmacology, 8th ed. Pp 130
18. Iswariah, Guruswami, Pharmacology and Pharmaco-therapeutics 7th reprint ed. Pp 746
19. Harrison, Principle of Internal Medicine, 9th ed. Pp 1527
20. A R Khuda Buksh et al, x-ray induced chromosomal aberrations and their alterations by the oral administration of a homoepathic drug. Arnica Mont., in mice. Proceedings of a seminar on the effects of environmental Agents on Genetical Systems, Calcutta, 18020 Oct 1982, Abstract: 2-3.
21. Dr Hahnemann, Organnon or Medicine, Eng trasl. By W Boericke, 6th ed ap. 273

Back