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
Some of the 'heads' like physical examination/ investigations etc are self-explanatory and therefore, they are not discussed here.
Thus, it will be quite obvious to the reader that the discipline which the Fever Format enforces on a novice is all-important for organizing his thought processes. But the Fever Format loses all its charm and operational value IF the case-taking is defective, though it is of great help in improving one's case taking, provided it is used with intellectual integrity and sincerity.
(2) Case-Taking:
Case Two then serves as an excellent example to demonstrate the importance of case-taking in Malaria cases and of selecting right prescription straightaway. The wrong/ partially similar remedy will distorting the totality and so confuse the prescriber that he will believe the 'wrong-remedy-image' is the right one. There ONLY saviour is Alertness. Dunham (quoted by Allen) rightly writes "The first duty of the physician is thorough examination of all the elements of the case. This cannot be stressed enough and most so in Malaria... (I can personally vouch for that, having had Malaria twice in last 1yr and both times had to finally resort to Allopathy- an anathema to a staunch Homoeopath like me!)
Having honestly ascertained all the elements let him consider them well and carefully before he decides on his first prescription, and make double sure before administering the first dose: no subsequent effort in the case is of so much import. A confusion at this level has again and again been ascertained as uncorrectable. After this there is only vexation, difficulty and anxiety before the physician ... Let it never be forgotten that time here is of no account; here accuracy wins hands down. It is infinitely better to do nothing than that to do wrong."
Allen writes on this issue: "After the totality of symptoms has been committed to writing, the most difficult part is done. The more time and care devoted to a careful and thoughtful examination of the patient, the less guessing and alternating and changing of remedies, afterwards; case well-taken is already half cured." Allen's Intermittent Fevers is a testimony of his acquired competence in treating Malaria cases; the arrangement of symptomatology speaks volumes about his Sherlock Holmes methods and procedures in case-taking. A homoeopathic physician is but a 'detective at work' when taking a Malaria case - his main interest lies in 'detecting' the right remedy sensitively and sensibly. Therefore, 'Selection of the Right Remedy or Remedial Forces", a topic, which will be discussed later cannot and must not be separated from the topic of 'Case-Taking' - in fact, it is an inseparable part of case-taking itself. Reasons will become clear as one reads further.
Why is Case-taking of Malaria so tricky and trying? Because the ailing patient is constantly taken up for his awful headache or backache or weakness or his overpowering chill or heat, thus tending to ignore or rather not give thought to the questions put up by the physician nor co-operative in narrating the experience in a meaningful way. Even the most experienced physician would be moved by the patient’s anxious moaning and suffering. Then, again, relatives, too are rendered tremendously anxious by P Falciparum, with its potential fatality and this puts a physician under stress resulting in a far from careful Anamnesis and evolutionary totality - all ingredients of a disaster in the making!
An Example of Case-Taking
A 35 yrs old woman (from a slum area) complained of fever with chill (now afebrile) and severe bodyache. While she was describing all this, she yawned twice or thrice. 'Are you feeling sleepy?" Yes, she said with embarrassment. 'Since how long have you been feeling sleepy?' She looked a little confused, smiled and hid her face in embarrassment. 'When did the fever start?' - Last night. 'Night is a long period', the physician said firmly but gently. - About 8 or 9 pm. And how do you know it was 8 or 9? She had gone to see Hindi news on TV. What did you feel at that time? She felt 'cold' and started shivering. (She coughed once.) Have you got cough? Yes. You did not report about it, why? You must report everything.
She said that it was quite mild. When did it start? Two days back she had got wet in the rain and since then very mild cough, one or two at a time, twice or thrice in a day. It is nothing much, but this fever was very high yesterday... and bodyache was very acute... 'You answer the questions correctly. I am going to treat your fever,' the physician said firmly 'When did you sit to watch TV?' She usually goes there at 8 pm. Was the fan on? Yes, she did not like it (unusual). Were you yawning there? Yes, yes, very much. The mistress of the house remarked that she looked sleepy and tired. What did you say? She said that she hadn't slept well for 2 days. Why? Bodyache and tired. Have you been working too hard? But the bodyache, whole body aches so much after getting wet. Sleep? Poor, because of bodyache. Dreams? She laughed.
Have you been getting dreams? She always gets dreams. What type of dreams since two days? Yesterday, she did not see any. Day before yesterday? She had been toiling at some work - hard manual work. And previous to that? She had been helping her mother on a field. How were you feeling yesterday at 6 pm? She was fine except the bodyache which was mild. 7 pm? Same 8 pm? Bodyache had increased - Cough? That was severe at 8 o'clock. 'Wait, wait,' the physician said quickly, "You said at 8 o'clock" - Does it mean that the cough was not present at 9 pm?' She thought with keen interest, now and then throwing glances at the physician's pen. After a while, she remembered it correctly - At nine o'clock, when the shivering started, the cough had almost disappeared for a while, but it had again started when she reached home. Dry or wet? Wet cough.
The mistress of the house gave her a clove to chew. Do you want to stretch your legs and arms? Yes, she liked it. (Her eyes showed surprise.) Was she doing that frequently yesterday evening? Yes, very much (The physicians knowing it all-look appeared on her face.) Headache? No. Colds? No. Nausea? No. Appetite? Not bad. Any Desires/ Aversions? She wants cold water. And during the chill? She drank matka (earthen pot) water. No, you did not answer my question - What you desire is one thing and what you drink is another. What did you desire to drink, cold water or matka water? She said that she was poor... No, the physician said firmly, what would you have preferred? Yes, she would have loved to have cold water. How is your back? Bad. Which is the most painful part in the body? Arms and legs - whole body.
Back? Better than the body. What relieves your bodyache? Tablet. No, apart from the tablet? Who would press the body, she moaned? Cold bath or warm bath? She is poor. How do you feel when you sit outside in the sun? Normally, she does not like sun, but since 2-3 days, she likes it because she feels better. Stools? No problem. Urine? No problem. Tongue? White. What makes the bodyache worse? Bath. Any other time? Night. Daytime? Not so much. During daytime, you must be working? Naturally! Does it mean that when you are moving around, you feel better? Exactly. In the morning, when she tries to get up from bed, the body is very painful - after wards, the pain wears off. Now think very carefully and answer the questions which I ask you - (the patient nodded her head) - Earlier, you said that you started feeling cold at about 9 pm, and then you started shivering, am I right?
Yes. Does it mean that there was no fever at that time or was there fever with it? No, no, the fever was there since evening! What time? Must be around 7 pm. The physician was quite perplexed. Look here, the physician said, ready to make the necessary changes on his Fever Format, this is something quite new you are saying, so please be careful in giving these details - How did you know there was fever? My body was warm. Did you measure the temperature? How can I? But the neighbours had said that my body was warm! And you had gone to see TV with fever? Yes, she laughed. The mistress there had also felt her body and said that she appeared warm, and had given her a chaddar (sheet to cover) for covering her body. So you are sure the shivering etc. started much later? Yes, she said emphatically. OK, then when did the shivering and 'cold feeling' subside? After about half an hour or so. Then what happened?
I fed my children? Does it mean you were not feeling cold then? No, I had removed all my covers. Sweat? No. You mean you did not sweat at all? No, no there was profuse sweat at night. What time? Must be after mid-night. Are you sure? Yes I got up wipe it. Now, let us revise the sequence again - You had fever (feeling warm) at about 7 pm, then you shivered at 9 pm and the sweat came on after midnight? High fever! She said simply. How did you know? Feeling very very warm. Fan? Off. Covers? None. The physician opened his repertory and studied it closely for a few minutes, and then wrote down on his Fever Format, under the heading.
Patterns: Heat, then Chill, then Heat, then Sweat. He verified it again and again from the patient. He quickly took the family history and past history to determine the predisposition and disposition. Family history/past history - not contributory.
Constitutional Remedy was obvious - Calcarea-carb, which is closely related to Rhus-tox. The patient was given one dose of Rhus-tox 200, one dose during apyrexia, and then a dose of the constitutional remedy. Thereafter, there have been no paroxysms till today.
Besides the methodology of case-taking, this 5th Case has been cited to demonstrate the indispensable importance and significance of the total anamnesis and the evolutionary totality of the case.
6th Case: One remembers the case of a young girl Kali-carb who came one late evening with mild fever and a few rhonchi. She had developed fever since morning. Her usual acute remedy (to which she has been responding very well), Arsenic-alb 1000 - 1 dose was given at 8 pm. Thereafter, the fever shot up to 104°F (Metacin was given at night.) Next morning, there was fever - 102°F to 103°F - it appeared to be a continuous type of fever. The blood-report was available at 11 am.(She had been on placebo ever since the dose of Arsenic-alb 1000). It was P. Vivax. There was a lot of confusion: Was this an aggravation because Arsenic-alb was prescribed during the paroxysm? If so, then, one had to wait. The physician waited almost for 36 hours. There were no clues available during 3-4 visits that he made. Finally, it was the anamnesis and evolutionary totality + absence of a balanced image of any phase remedy which solved the problem: 1ST Day - fever without chill at 9 am Pricking pain in throat in the morning Kali-carb 10M, 1 dose was needed. (At the moment of this crucial decision, the fever was 104°F. One dose of Metacin was administered was given to bring fever to manageable level. Kali-carb 10M was prescribed when the temperature came down to 102°F).
