Homoeopathic Management of Malaria
NATIONAL JOURNAL OF HOMOEOPATHY 2004 Sep / Oct VOL VI NO 5.
Dr Hitesh Purohit
'Ars-alb / Eup-perf / Nux-v / Nat-m / Calc-c / Rhus-t / Ars-a / Kali-c / Mag-c / Tub-b / Nat-m

Defining The Problem: Case Taking
Introduction
The astounding discovery of Homoeopathy is closely related to Malaria and the Cinchona bark extract experiments, The "Malaria-like" symptoms greatly facilitated the discovery of the Therapeutic Law of Cure by Hahnemann.

Once the Law was made applicable to treatment of masses, including Malaria or Intermittent Fevers, successes and failures were both aplenty. These, when analyzed judiciously, helped Hahnemann to gradually build up the entire Homoeopathic Theory and elaborate it in the Organon. Allen followed, with his superb 'Therapeutics of Fever'. The more recent experiences however remained more or less unorganized and hence unavailable in print to the fraternity.

We were forced to grapple with Malaria over the last few yrs due to its endemicity status in most parts of India.

Our Earliest Encounters with Malaria
Once a physician almost sent a patient of malaria to his death, by administering repeated doses of Arsenic-alb 30 (the indicated remedy) during the paroxysm.

The course which followed: patient moved from nervous restless anxious? fearful delirious with fever shot upto 107°F and severe anxiety about death. A dose of paracetamol quelled the storm, temporarily. The patient and the relatives were then wise enough to switch over to modern medicine. The physician was shocked by the experience and vowed never to treat a case of Malaria again.

Providence was kind to him and thrust upon him the responsibility of treating another case of Malaria. Reluctantly, the 'Organon' which had been collecting dust on the top shelf was taken down and he meekly took note of Hahnemann's admonishments:

Take total care in taking the case, record it well. Study it thoroughly. Select the right remedy. Administer the (single) remedy after the paroxysm is over.

The second case was taken in detail and very meticulously. A thorough study of it again revealed Arsenic-alb as the similimum. The physician after waiting patiently administered a dose of Ars-alb 30. The next paroxysm was due the next day.

Next Day: 3 pm Telephone rang. Fever 104°F (First paroxysm 102°F). The voice wailed, "Doctor, he is too bad today. Tossing restlessly on bed. I have never seen tears in his eyes. His headache and backache are worse; he has severe nausea. His condition is bad, too bad! He is saying that he is going to die." That is Arsenic personified, the bewildered physician muttered to himself, looking questioningly at 'Organon' as if to ask what has gone wrong, Dr Hahnemann? He quickly and wisely prescribed a dose of Paracetamol and offered consolation to the desperate wife promising that he would visit late in the evening.

9 pm: The physician was greeted with a pale smile. The temperature was normal but the headache and backache were not relieved at all. The worried physician maintaining his composure consoled the patient and the anxious relatives: "There is nothing to worry. It is only a question of potency ("Hope you are right, Dr Hahnemann") Once the right potency is administered, he will be all right." He could see that the patient had noticed his feeble voice, so he at once turned to examine the patient (though there was hardly anything to examine) and asked a few questions to confirm his prescription of Arsenic. Satisfied he left. At the door the patient timidly asked if he could occasionally take cold water to drink. Yes, yes, why not? The physician assured him good humouredly and went away.

The physician was restless. Intuitively he felt something was wrong. He studied Arsenic from Allen's Intermittent: "Chill: If there be thirst during chill except for hot drinks, do not give Arsenic - H N Guernsey." Patient was thirsty³ all right, but whether he desired warm or cold - and that too during chill - had not been inquired at all! His pride began to melt and he immediately dialed the patient. What sort of water does he want? Doctor, we have been giving him warm water only - why?

No, what does he desire? He wants cold water - ice cold water! One cannot give cold water during fever, can one? What sort of water does he want when he is shivering with chill? Doctor he has been demanding ice cold water even when he is shivering from head to toe but that can be very harmful ... And when he is not shivering and removes the covers? He is not very thirsty then but he still wants cold water, but I don't ... How is his headache? Very bad - two Metacins have not given relief... How much did he sweat today? Not much - hardly at all, even after two Metacins ... And backache? Very bad, right from the beginning, it has been going on pretty badly.

Backache was the first symptom at 9 am on the first day. Bitter taste and mild nausea at 11 am. There was no restlessness or weakness till 5 pm when the fever was 102°F at the time when the case had been taken. The patient said he was feeling very weak because he was feeling 'terrible' - headache and backache were so severe that he could hardly sit! Wife added that he had a tendency to exaggerate during sickness. At 2 pm (on the 1st day) he started feeling thirsty - quite unusual - and as soon as he had taken a glass full of cold water (he still wanted more, but the sudden chill with rigor prevented him to do so) the chill had set in vigorously. He had once or twice asked for cold water but the wife had prevented it saying that he would get Pneumonia.

The patient did not have the courage to offend his caring wife, and obliged by sipping a little warm water that she offered him from time to time. On the first visit: as the physician entered the room he saw the patient sip a little water. On inquiry the wife, who had been eagerly waiting to report everything, had said that the patient was feeling thirsty, and she had been giving warm water every few minutes. Everyone had become very nervous and anxious on seeing the Blood-Report - Plasmodium Falciparum positive. The wife remarked he always becomes nervous, impatient and irritable during sickness. He was very nervous today. When did the paroxysm start? In the afternoon between 2-3 pm. Chill and nausea increased with sips of water which was more because of disgust for warm water. Now what more do you require to prescribe Arsenic-alb? The physician had not taken into account the Anamnesis and the Evolutionary Totality- his case-taking was far from adequate. Fortunately, the patient had not taken the dose of Arsenic-alb 200 at night (the second paroxysm). Eupatorium-perf 200 single dose was prescribed. There were no paroxysms thereafter.

Physician had become wiser, His remorsefulness much alleviated, he went through Allen's Intermittent Fevers and Organon. Retrospection was inevitable. Why had he so thoughtlessly ignored Hahnemann's exhortations despite the fact that he had read his aphorisms 235 to 244 a number of times?

Retrospectively, when the physician had his first encounter, he had obviously set aside the implications of Malaria being an emerging acute phase of a chronic disease. The concept of Deep Acting Anti-Psoric as mentioned by Dr Hahnemann could not be taken lightly.

Third Case: A regular patient of mine, contracted P Vivax and was treated with the Phase Remedy Nux-vom 200. The paroxysms subsided with a single dose. Thereafter she did not report. After 2 days she had a recurrence at Delhi, a little modified picture yet Nux-vom emerged strongly. One single dose in 200 potency, and one single dose of the constitutional remedy (Nat-mur 1M) 36 to 48 hrs was given after the paroxysm was over. She was all right and has not had a relapse till today.

It is a general experience that we often discover what 'we will do', by finding out what 'we will not do'; and probably he who never made a mistake, never made a discovery that Hahnemann as a True Experimenter had followed this painstaking path.

Fortunately, Hahnemann had brilliant followers like Boenninghausen, Boger, Allen and others to justify his discovery of these 'therapeutic laws' by verification. An enthusiastic reader can easily verify this by going through Allen's Introduction to his Intermittent Fevers - a classic in Homoeopathic Literature. (Allen is the greatest known authority in Malaria.) We can never 'feel' to the full what Hahnemann and Allen have written with total conviction until we have traversed the same path Many important facts:

(1) The ICR Fever Format: Learning accrues to the teacher from experiences based on Organon. The teacher shares his learning with the learners. Analysis inevitably occurs. This is the way concepts evolve. To make these concepts useful at an operational level, standardization of concepts/ methods/ techniques is indispensable.

However, with more and more encounters with Malaria cases and learners, the fever totality section proved to be too inadequate and incomplete for further analyses - research Philosophy of treatment and management of Malaria Learning. Hence, the ICR (Intermittent) fever format is an organized arrangement of Hahnemannian concepts (as elaborated in the ICR symposium volumes) to facilitate case-taking, case-study, analysis, synthesis, repertory study, homoeopathic Materia Medica study and planning and programming of treatment. This now brings us to a brief discussion on the various sections in the ICR fever format.

The 1st Section in the Fever Format is for recording the total anamnesis and the evolutionary totality. The narration by the patient as guided actively by the physician is 'committed to writing' verbatim. The important Time Axis, serving to check the alert and sensitive physician, is provided to guide the physician.

Caution: The patient almost always begins with the chill or fever. It is always safe to help the patient recollect his symptoms that might have developed 24 hours before the onset of chill or fever. Sometimes, it is necessary to go back even beyond this. The physician should not try to separate or distinguish between different stages in this section. This, of course, should not prevent him from procuring the characteristic / peculiar / individualizing symptoms with the available modalities etc.

'Patterns' is the immediate heading that follows. Refer Kent's repertory - fever, Succession of Stages; Boger-Boenninghausen's repertory - compound fevers. The types of pattern the patient is manifesting will correspond to one of the descriptions in these sections of the repertories. This offers valuable clue for the selection of the remedy.

Evaluation will necessarily be practiced as per principles laid down in the text-book by Dr M L Dhawale.

Presence of chronic disease will necessarily have its bearings on the sensitivity / susceptibility of the patient. The miasmatic background gets more accurately defined. The effects will be felt at the level of posology, the study of which is still incomplete and inadequate. It can be considered as the 'Foresight' of future posology.

Drugs: Which the patient has been taking will be listed here and in what way they are tampering with the patient's susceptibility will be assessed. This will naturally include the anti-malarial drugs also.

Remedy Selection: Is the most important aspect and will be considered seriously with reference to the Symposium Volume - D pages 10 to 14. The phase of disease expression will be mentioned with reasons. Similarly, pre-disposition and disposition will be clearly defined. The significance of these aspects need not be discussed here.

In the type of relationship, it would be wise to note down all the remedies which are closely related to the constitutional remedy or the phase remedy. This helps the physician in considering each and every likely remedy for selecting the first Prescription. This way the chances of making mistakes are minimized to a great extent.

Symptoms not recorded in the HMM or Repertories: Experience soon teaches an alert/sensitive/enthusiastic physician that our greatly adored H M M and Repertories are still incomplete - quite an unpleasant surprise! Therefore, all the symptoms (in a patient) which were not traceable to these Source Books should be listed here. In future, this will enable us collectively to make necessary changes in the HMM and Repertories. (Example: A patient of bronchitis - constitutional remedy: Nat-mur Acute - Kali-carb - developed malaria. During the prodrome, he had moderate pain in teeth. However, the rest of the picture - Anamnesis and the evolutionary totality - pointed to Arsenic-alb as the phase remedy. Arsenic-alb cleared the case, relieving the pain in teeth. It is possible to find Arsenic-alb in the appropriate rubrics in the repertories and H M M)

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