i

“A STUDY OF REMEDY PROFILE IN THE TREATMENT OF POLYCYSTIC

OVARIAN SYNDROME”

by

Dr C.S. SUBHA PRADHA

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfilment

of the requirements for the degree of

Doctor of Medicine

in

Homoeopathic Materia Medica

Under the Guidance of

Dr Srinath Rao

Department of Materia Medica

Father Muller Homoeopathic Medical College and Hospital,

Deralakatte, Mangalore

2012

ii

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis entitled “A STUDY OF REMEDY

PROFILE IN THE TREATMENT OF POLYCYSTIC OVARIAN SYNDROME” is

a bonafide and genuine research work carried out by me under the guidance of

Prof. Dr SRINATH RAO, MD (Hom), Professor & HOD, Department of Homoeopathic

Materia medica.

Place: Mangalore Date: Dr C. S.SUBHA PRADHA

iii

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A STUDY OF REMEDY

PROFILE IN THE TREATMENT OF POLYCYSTIC OVARIAN SYNDROME” is

a bonafide research work done by Dr C.S. SUBHA PRADHA during the year 2009 –

2012, as a partial fulfilment of the requirement for award of the degree of “DOCTOR

OF MEDICINE (HOMOEOPATHIC MATERIA MEDICA).

Date:

Place: Mangalore

GUIDE:

Dr SRINATH RAO

B.H.M.S, MD (HOM)

Professor & HOD

Dept. of Materia Medica,

Father Muller homoeopathic medical

College and Hospital,

Derlakatte, Mangalore

iv

ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE

INSTITUTION

This is to certify that the dissertation entitled “A STUDY OF REMEDY

PROFILE IN THE TREATMENT OF POLYCYSTIC OVARIAN SYNDROME” is

a bonafide research work done by Dr C.S. SUBHA PRADHA during the year 2009 –

2012, as a partial fulfilment of the requirement for the award of the degree of “Doctor Of

Medicine (Homoeopathic Materia Medica)” under the guidance of Dr SRINATH

RAO.

HEAD OF THE DEPARTMENT:

Dr SRINATH RAO,

B.H.M.S, MD (Hom)

Department of Materia Medica

Father Muller Homoeopathic

Medical College and Hospital

Derlakatte, Mangalore.

Date:

Place:

PRINCIPAL:

Dr SRINATH RAO,

B.H.M.S, MD (Hom)

Department of Materia Medica

Father Muller Homoeopathic

Medical College and Hospital

Derlakatte, Mangalore.

Date:

Place:

v

COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this dissertation / thesis

in print or electronic format for academic / research purpose.

Place: Mangalore Date: Dr C.S. SUBHA PRADHA

© Rajiv Gandhi University of Health Sciences, Karnataka

vi

ACKNOWLEDGEMENT I consider this as my privilege to thank the Almighty God for helping me to

achieve this humble task through the following persons who have been of immense help

and source of encouragement in my endeavor.

I would like to thank my dear parents Mr. Sri Kumar Krishnan, Mrs. Sakunthala

and my brother Mr. Sathish for giving me constant love and support in every aspect of

my life.

I would like to express my sincere and heartfelt thanks to my respected and

beloved teacher and guide Prof. Dr SRINATH RAO, Principal and Head of the

Department of Homoeopathic Materia Medica, for providing expert guidance,

constructive advice, freedom of thought, personal attention, timely support and

encouragement throughout my post graduate course and during the dissertation work. It is

my good fortune to do this work under his guidance.

It is my privilege to express my gratitude to Director, Rev. Fr. Patrick

Rodrigues, Father Muller Charitable Institutions, The Administrator, Rev. Fr. Wilfred

Prakash, Father Muller Homoeopathic Medical College, for providing me adequate

facilities to carry out this work.

I would like to extend my thanks and gratitude to Dr Srinath Rao, Principal and

Head of Department of Materia Medica and Former Principal Dr SK Tiwari, for

fulfilling the necessities and guidance in my academic activities.

I also express my heartfelt thanks and gratitude to Dr Sunny Mathew, Medical

Superintendent, for his constant support, care and attention given in all possible ways and

also for his timely attention to our minutest requirements for completion of our study.

vii

I express my sincere thanks to my P.G. Coordinator, Dr M.K. Kamath, Head of

Department of Medicine, for his valuable support for my academic activities.

A special thanks to Dr Guruprasad who gave his valuable suggestions for my

dissertation and also guiding us in other academic activities. I am failing in my duties if

am not mentioning my sincere gratitude to Dr Girish Navada, Dr Amitha Baliga,

Dr Anitha Lobo, Dr Prasanna Kumar, Dr Blanny Lobo and Dr Vilma D’ Souza for

their constant support, encouragement and for giving me the freedom of thought in out –

patient department.

I extend my gratitude to all my classmates, for helping me in various other aspects

during my studies, whose cooperation and timely help considerably eased my task. I also

thank all my seniors who gave their constant support.

I would like to thank my dear friends Dr Anu Joseph and Dr Praveen Kulkarni for

giving me constant love and support in every aspect of my life. I also thank my

juniors Dr Salini Mandal, Dr Hilarity, Dr Prasanna Lakshmi, Dr Sivaranjni, Dr Abarna

and Dr Manju for their timely help in doing this work.

I thank all the non – teaching staff of Fr. Muller Homoeopathic medical college

and the staff of out – patient department who provided me with the case material required

for the study.

Last but not the least, my sincere thanks to all the Patients on whom the study

was conducted and A1 Solutions, Kankanady.

Place: Mangalore

Date: Dr C.S. SUBHA PRADHA

viii

LIST OF ABBREVIATIONS USED

A: Absent

ACTH: Adrenocorticotropic Hormone

Agg or <: Aggravation

Amel or >: Amelioration

Av: Aversion

Cr: Craving

: Decrease

DHEAS: Dehydroepiandrosterone Sulphate

DM: Dominant Miasm

EET: Essential Evolutionary Totality

FGT: Female Genital Tract

FM: Fundamental Miasm

FMP: First Menstrual Period

FSH: Follicle Stimulating Hormone

GnRH: Gonadotropin Releasing Hormone

Gr: Grain

HS: Hora Somni (At bed time)

ix

IGF: Insulin like Growth Factor

: Increase

LH: Luteinizing Hormone

LMP: Last Menstrual Period

LTS: Litres

NO: Number

P: Packet

PCOS: Polycystic Ovarian Syndrome

R/O: Ruling out point

S: Same

SCR: Standardized Case Record

SHBG: Sex Hormone Binding Globulin

SL: Sac Lac

SOS: Si Opus Sit (If required)

USG: Ultrasonography

Wt: Weight

Yrs: Years

x

ABSTRACT

Background:

Polycystic Ovarian Syndrome is a disorder of the ovary where the Graafian

follicles fails to mature and rupture and thus resulting in the formation of cysts in the

periphery of the ovary. This includes a heterogeneous group of patients who may present

to a gynaecologist with subfertility or menstrual problems or to an endocrinologist with

obesity, hirsutism or acne/skin problems. This disease may have an enriched

psychosomatic relationship.

According to Homoeopathy, it is the man who is sick and not his body and as a

matter of fact he needs to be treated. It is here the concept of individualization comes

into practice, where the physical as well as the mental characteristics of the individual is

taken.

Objectives:

1. To study the remedy profile in the treatment of polycystic ovarian syndrome.

2. To highlight the homoeopathic approach in treatment of polycystic ovarian syndrome.

Methods:

A total number of 30 cases were screened aged between 15 – 30 yrs for the study.

The diagnosis was made on basis of strong clinical presentation, examination finding as

well as investigations, if required. The cases were selected for the study after fulfilling

the inclusion as well as exclusion criteria. The case selection was done randomly.

xi

The remedy selection in individual cases was based on the analysis of

constitutional picture, Repertorial references and Materia Medica. Improvement in each

case were analyzed and ‘t’ test was applied to the former scoring of the statistical

analysis.

Results:

Maximum prevalence was noticed in:

Age group: 20 – 25 yrs, 13 cases (43.33%)

Religion: Hindu, 16 cases (53.33%)

Occupation: Student, 16 cases (53.33%)

Miasmatic expression: Sycosis, 16 cases (53.33%)

Medicine: Natrum mur, 10 cases (33.33%)

Potency selection: 200th potency was used in maximum number of cases 9 cases (30%)

during the beginning of the treatment but by the end of the treatment, 1M potency was

used in maximum number of cases i.e. 15 cases (50%)

Outcome: 25 cases (83.33%) showed improvement.

Conclusion:

The scale used for assessment and effectiveness of treatment showed significant

improvement after treatment. From the analysis of the above results obtained it is obvious

that Homoeopathic treatment is effective in Polycystic Ovarian Syndrome.

xii

SL.

NO

TABLE OF CONTENTS PAGE

NO.

1. INTRODUCTION 1

2. AIMS AND OBJECTIVES 4

3. REVIEW OF LITERATURE 5

4. METHODOLOGY 64

5. RESULTS 68

6. REMEDY PROFILE 84

7. DISCUSSION 101

8. CONCLUSION 106

9. LIMITATIONS 107

10. SUMMARY 108

11. BIBLIOGRAPHIC REFERENCES 109

ANNEXURE – I 114

ANNEXURE – II 116

ANNEXURE -- III 160

xiii

LIST OF TABLES

TABLE NO. TITLE PAGE NO.

1 Distribution of cases according to age 69

2 Distribution of cases according to religion 70

3 Distribution of cases according to occupation 71

4 Distribution of cases according to clinical presentation 72

5 Distribution of cases according to miasm 74

6 Distribution of constitutional medicines used in this

study

75

7 Distribution of cases according to potency of

Homoeopathic Medicines used in this study

(Constitutional Medicine)

76

8 Distribution of cases according to the treatment outcome 78

9 Distribution of the scores before and after the treatment 80

xiv

LIST OF FIGURES

FIGURE NO TITLE PAGE NO.

1. Normal anatomy of female reproductive system 7

2. Arterial and venous supply of female reproductive system 8

3. Histology of ovary 10

4. Stages in oogenesis 11

5. Changing hormone levels during the menstrual cycle 16

6. Mechanism of PCOS 22

7. Appearance of normal ovary and ovary with PCOS 23

8. Hirsutism 23

9. Acanthosis nigricans 24

10. Appearance of PCOS in ultrasonography 25

11. Distribution of cases according to age group 69

12. Distribution of cases according to religion 70

13. Distribution of cases according to occupation 71

14. Distribution of cases according to clinical presentation 73

15. Distribution of cases according to miasm 74

16. Distribution of cases according to remedies prescribed 76

17. Distribution of cases according to the potency 77

18. Distribution of cases according to treatment outcome 78

19. Statistical analysis 79

Introduction

1

INTRODUCTION

Polycystic ovarian syndrome is a problem in which a woman’s hormones are out

of balance. It can cause problems with the menses and make it difficult to get pregnant.

PCOS may also cause unwanted changes in the way one look. If it is not treated, over

time it can lead to serious health problems, such as diabetes and heart disease.

Polycystic ovarian syndrome (or PCOS) is common, affecting as many as 1 out of

15 women. Often the symptoms begin in the teen years. Treatment can help control the

symptoms and prevent long-term problems

Polycystic ovarian syndrome (PCOS) is one of the most common female

endocrine disorders and a common inherited genetic condition. It is inherited in an

autosomal dominant system with high genetic penetrance but variable expressivity in

females, meaning that each child has a 50% chance of inheriting the gene from a parent

who carries the gene, and if a daughter receives the gene, then the daughter will have the

disease to some extent. PCOS produces symptoms in approximately 5% to 10% of

women of reproductive age and is thought to be one of the leading causes of female sub

fertility

Polycystic ovarian syndrome (PCOS) is the 4th gynaecological problem of hospital

admission. About 15 – 20 % of women in reproductive age group are affected by PCOS.

The symptoms of PCOS may begin in adolescence with menstrual irregularities, or a

2

woman may not know that she has PCOS until later in life when symptoms and/or

infertility occur. Women of all ethnicities may be affected

PCOS has a wide spectrum of consequences and thus needed to be treated

completely and as soon as possible. PCOS is more common in adolescent age group

where the patients will be suffering from abnormal bleeding as a result of anovulation

within one year of menarche.

In modern system the line of management is usually by hormonal therapy or

surgery. But if a condition is removed by surgery without any attempt being made to

correct the constitutional state that has lead to a disease, the chances of recurrence are

great and it worsens the condition. So the cause of the disease should be removed and not

the result.

Removal of the local symptoms of the local affections by administration of

unhomoeopathic remedies leads to rousing up of the internal disease and other symptoms

that previously existed in a latent state side by side with the local affection.

The cases which have been treated with allopathic remedies for a long period of

time, the main symptoms become suppressed powerfully into deeper regions of the

organism and the defence mechanism becomes severely hampered in its action.

The organon condemns on the principle of the removal of the external

manifestations of disease by an external means whatever. The signs and symptoms that

are manifested are the true impress of nature; they constitute the outwardly reflected

image of the inward nature of the disease.

3

Considering the psychosomatic relationship in polycystic ovarian syndrome, a

detailed case taking is necessary to obtain a psychological profile which helps in person

diagnosis, disease diagnosis and management of case, both specific as well as general.

As the Homoeopathic system is based on natural principles of cure, it does not

produce any side effects, it acts into deeper levels and increase the vitality of an

individual by stimulating the vital force and thereby preventing the disease process to

progress further. Thus, there are apparently less chances of disease going into deeper

regions of organism.

As there is no much curative treatment for PCOS in modern system of medicine

where the treatment is palliative or suppressive, my interest is to know if there is any

effective treatment for PCOS in homoeopathy and so I took this study to know the

efficacy of homoeopathic treatment in PCOS and also to do a study on remedy profile on

PCOS.

Aims & Objectives

4

AIMS AND OBJECTIVES

1. To study the remedy profile in the treatment of polycystic ovarian syndrome.

2. To highlight the homoeopathic approach in treatment of polycystic ovarian syndrome.

Review of Literature

5

REVIEW OF LITERATURE

The ovary is an ovum producing reproductive organ, often found in pairs as part

of vertebrate female reproductive organs. Ovaries are oval shaped paired organs situated

in the lateral wall of the pelvis in a region called the ovarian fossa. The ovaries are

attached to the outer latter of the uterus via the ovarian ligaments. Usually each ovary

takes turns releasing eggs every month; however if there was a case where one ovary was

absent or dysfunctional then the other ovary would continue providing eggs to be

released.1

Ovaries are the female gonads which correspond to the testes in males. These

ovaries secrete two hormones namely oestrogen and progesterone. Oestrogen is

responsible for the appearance of secondary sexual characteristics of anatomically female

people at puberty and for the maturation and maintenance of the reproductive organs in

their mature functional state. Progesterone functions with oestrogen by promoting the

menstrual cycle changes in the endometrium.2

DEVELOPMENT OF OVARY:

In female embryos with an XX sex chromosome complement and no Y

chromosome, the primitive sex cords dissociate into irregular cell clusters. These clusters,

containing groups of primitive germ cells, occupy the medullary part of the ovary. Later

they disappear and are replaced by a vascular stroma that forms the ovarian medulla.

The surface epithelium of the female gonad, unlike that of the male, continues to

proliferate. In the seventh week, it gives rise to a second generation of cords, called the

cortical cords, which penetrate the underlying mesenchyme but remain close to the

6

surface. In the fourth month, these cords split into isolated cell clusters, with each

surrounding one or more primitive germ cells. Germ cells subsequently develop into

oogonia and the surrounding epithelial cells, descendants of the surface epithelium, form

follicular cells.

It may thus be stated that the genetic sex of an embryo is determined at the time of

fertilization, depending on whether the spermatocyte carries an X or a Y chromosome. In

embryos with an XX sex chromosome configuration, medullary cords of the gonad

regress and a secondary generation of cortical cords develops. In embryos with an XY

sex chromosome complex, medullary cords develop into testes cords and secondary

cortical cords fail to develop.

Descent of the ovary:

In fetus the ovaries are situated in lumbar region. Descent of the gonads is

considerably less in the female than in the male and the ovaries finally settle just below

the rim of the true pelvis. The cranial genital ligament forms the suspensory ligament of

the ovary, whereas the caudal genital ligament forms the ligament of the ovary proper and

the round ligament of the uterus, the latter extends into the labia majora.3

ANATOMY OF THE OVARIES:

The ovaries are the female gonads. The female gametes called the oocytes are

formed in them. Each ovary lies in the ovarian fossa on the lateral pelvic wall. The

ovarian fossa is bounded anteriorly by the obliterated umbilical artery and posteriorly by

the ureter and the internal iliac artery. Each ovary is about 4cms in length, 2cms in width

and about 8mm in thickness and weighs from 2 to 3.5gms

7

Regarding the external features of ovaries; in young girls, before the onset of

ovulation, the ovaries have a smooth surface which are greyish pink in colour. After

puberty, the surface becomes uneven and the colour changes from pink to grey. Each

ovary has two poles or extremities, the upper or tubal pole and the lower or uterine pole;

two borders, the anterior or mesovarian border and the posterior or free border; and two

surfaces, lateral and medial.

Figure 1: Normal anatomy of female reproductive system

Vessels and nerves:

The ovaries are supplied by the ovarian artery which arises from the abdominal

aorta just below the renal artery. The uterine artery also gives some branches which reach

the ovary through the mesovarium. The veins that drain the ovaries emerge at the hilus

and form a pampiniform plexus around the artery. The plexus condenses into a single

8

vein near the pelvic inlet. This vein ascends on the posterior abdominal wall and drains

into the inferior vena cava on the right side and into the left renal vein on the left side.

The lymphatics from the ovary communicate with the lymphatics from the uterine

tube and fundus of the uterus. They ascend along the ovarian vessels to drain into the

lateral aortic and pre aortic nodes. Regarding the nerve supply, the ovaries are supplied

by the ovarian plexus, derived from the renal, aortic and hypogastric plexuses and

accompany the ovarian artery. It contains both sympathetic and parasympathetic nerves.

Sympathetic nerves (T 10, T11) are afferent for pain as well as efferent or vasomotor.

Parasympathetic nerves (S2, S3, and S4) are vasodilator.4

Figure 2: Arterial and venous supply of the female reproductive system

9

HISTOLOGY OF OVARY:

Histologically, the ovary is made of the following parts from without inwards:

Germinal epithelium of cubical cells, derived from peritoneum.

Tunica albuginea is a thin layer of connective tissue.

The cortex has compact layers and consists of glandular structures which represent

ovarian follicles at different stages of development; connective tissue cells and

interstitial cells with fine lipid granules formed mainly from theca interna.

The cortex contains ovarian follicles at various stages of development. Each

follicle contains one oocyte. One follicle matures every month and sheds an oocyte. Total

of 400 oocytes are ovulated in the reproductive life.

Liberation of an oocyte from the ovary is called ovulation. It occurs on or about

the 14th day of a 28 day menstrual cycle. After the oocyte is liberated, the Graafian

follicle is converted into a structure called the corpus luteum.

The hormone oestrogen is secreted by the cells in the walls of ovarian follicles.

Another hormone, progesterone is produced by the corpus luteum.

The innermost layer is the medulla which is otherwise known as zona vasculosa. It

has the stroma of loose connective tissue. It contains blood vessels, lymphatics, nerve

fibres and bundles of smooth muscle fibres near the hilum.4

10

Figure 3: Histology of ovary (showing different stages of follicle development)

PHYSIOLOGY OF OVARIES:

1. Secretion of female sex hormones:

The ovaries secrete oestrogen and progesterone. The former is secreted by the

follicular and paraluteal cells. The major function of the oestrogen is to promote cellular

proliferation and tissue growth in the sexual organs and in other tissues related to

reproduction. In childhood, the oestrogen is secreted in small quantities. During puberty,

the secretion increases sharply resulting in the changes with the final preparation of the

uterus for pregnancy and the breasts for lactation. Ovaries also secrete inhibin, relaxin

and small quantities of androgens.

2. Oogenesis and menstrual cycle: Oogenesis is the process by which mature ova (egg

cells) are produced in the ovary. The maturation of oocytes begins before birth. Once

primordial germ cells have arrived in the gonad of a genetic female, they differentiate

11

into oogonia. These cells undergo a number of mitotic divisions and by the end of third

month, are arranged in clusters surrounded by a layer of flat epithelial cells. Whereas all

of the oogonia in one cluster are probably derived from a single cell, the flat epithelial

cells, known as follicular cells, originate from surface epithelium covering the ovary. All

the oogonia to be used throughout the life of a woman are produced at a very early stage

(possibly before birth) and do not multiply thereafter.5

Oogonium

Enlarges to form

Primary oocyte

First meiotic division

Secondary oocyte 1st polar body

22+ X

Second meiotic division

2nd polar body

Ovum 22+X

Figure 4: Stages in oogenesis6

Formation of ovarian follicles:

Ova develop from oogonia present in the cortex of the ovary. The oogonia are

surrounded by other cells that form a ground work (or stroma) for them. These stromal

22+ X

44+X+X

22+X

44+X+X

12

cells form the ovarian or Graafian follicle that surrounds the ovum and protects it. The

stages in the formation of the follicle are:

1. Some cells of the stroma become flattened and surround an oocyte. These flattened

cells ultimately form the ovarian follicle and are therefore called follicular cells.

2. The flattened follicular cells become columnar. Follicles up to this stage of

development are called primordial follicles.

3. A homogenous membrane, the zona pellucida, appears between the follicular cells

and oocyte.

4. The follicular cells proliferate to form several layers of cells which constitute the

membrane granulosa. The cells may now be called granulosa cells.

5. A cavity (or antrum) appears within the membrana granulose. With its appearance a

follicle is formed.

6. The cavity of the follicle rapidly increases in size. The oocyte now lies eccentrically

in the follicle, surrounded by some granulosa cells that are given the name cumulus

oophoricus. The cells that attach it to wall of the follicle are called discus proligerus.

7. As the follicle expands, the stromal cells become condensed to form theca interna

which secretes oestrogen.

8. Outside the theca interna some fibrous tissue becomes condensed to form another

covering called theca externa.6

At 7th or 8th month of intrauterine life, about 6 million primordial follicles are

found in the ovary. But at the time of birth, only 1 million primordial follicles are seen in

both the ovaries and the rest of the follicles degenerate. At the time of puberty, the

13

number decreases further to about 3,00,000 to 4,00,000. After menarche, during every

menstrual cycle, one of the follicles matures and releases its ovum.7

Ovulation:

Ovulation is the process by which the graafian follicle in the ovary ruptures and

the ovum is released into the abdominal cavity. Ovulation occurs on 14th day of menstrual

cycle in a normal cycle of 28 days. The ovum which is released into the abdominal cavity

enters the fallopian tube through the fimbriated end of the tube. LH is responsible for

ovulation.7

Ovarian cycles and hormones:

The changes taking place during the ovarian cycles are greatly influenced by

certain hormones produced by the hypophysis cerebri. These are the FSH and LH. The

hormones produced by the theca interna and by the corpus luteum that is oestrogen and

progesterone in turn influence other parts of the female reproductive system, resulting in

a cycle of changes referred to as uterine or menstrual cycle.8

Physiology of menstruation:

The cyclic events that take place in a rhythmic fashion during the reproductive

period of a woman’s life is called menstrual cycle. The menstrual cycle starts at the age

of 12 to 15 years, which marks the onset of puberty. The commencement of menstrual

cycle is called menarche7. The menstrual cycle as such originates in the ovary. The

monthly cycle of the LH/FSH surge and consequent ovulation is mainly a rhythm induced

by the ovary itself, rather than the result of an inherent rhythm generated within the

central nervous system.8

14

The menstrual cycle comprises of 4 phases:

1. Proliferative/ Follicular phase.

2. Ovulation

3. Luteal phase/ Secretory phase

4. Menstrual phase.

Proliferative/ Follicular phase:

It extends from 5th day of the cycle until the time of ovulation that is 14th day. The

changes occurring in ovaries are called follicular phase and that in uterus is called

proliferative phase. During this phase, there is maturation of ovum with development of

ovarian follicles through different stages (hence the name follicular phase).

Primordial follicle Primary follicle Vesicular follicle Graafian follicle

Meanwhile in the uterus there will be rapid proliferation of the endometrial cells

(hence the name proliferative phase). The epithelium which was shed in the menstrual

phase reappears on the surface of the endometrium within the first 4 to 7 days. The

uterine glands start developing within the endometrial stroma. Blood vessels also appear

in the stroma. All these changes in uterus are because of the influence of oestrogen. Also

the epithelial cells of vagina are cornified. Mucus membrane of cervix becomes thinner

and more alkaline.

Ovulation: Ovulation is the process in which there is rupture of the graafian follicle with

consequent discharge of the ovum into the abdominal cavity. This is influenced by LH.

This phase usually occurs on the 14th day of the menstrual cycle in a normal cycle of 28

days. The ovum is then picked by the fimbriae of the fallopian tube.

15

Luteal/ Secretory phase:

This phase extends from 15th to 28th day of menstrual cycle. During this phase

corpus luteum is developed in the ovary and hence the name luteal phase whereas in

uterus there is further enlargement of the endometrial glands which commence their

secretory function (under the influence of progesterone secreted by corpus luteum) and

hence the name secretory phase. Corpus luteum is a glandular yellow body developed

from the ruptured graafian follicle after the release of ovum. Secretory phase is the

preparatory period during which the uterus is prepared for implantation of fertilized

ovum. At the end of this phase, the endometrial thickness is 5 – 6mm. Vaginal epithelium

is infiltrated with leucocytes and also the cells of the epithelium proliferates both of

which resists against infection. Because of actions of progesterone during this phase, the

mucus membrane of cervix becomes more thick and adhesive.

Menstrual phase:

After ovulation, if the fertilized ovum is implanted on the uterine wall, pregnancy

occurs. Otherwise the thickened endometrium is shed along with blood, ovum and tissue

fluid. This phase lasts for about 4 – 5 days and is called menstrual phase or menstrual

period.7, 8

16

Figure 5: Changing hormone levels during the menstrual cycle

POLYCYSTIC OVARIAN SYNDROME: (PCOS)

Polycystic ovarian syndrome is a heterogeneous clinical disorder, which affects

about one in ten women in their reproductive age and causes cosmetic, emotional and

menstrual problems. PCOS is currently considered to be the most common

endocrinopathy as well as the most common cause of hyper androgenic anovulatory

infertility among women.9

It was before called as Stein – Leventhal syndrome. It is a heterogeneous

endocrine disorder with primary morphological changes. 15 – 20% of female population

suffers from PCOS and the patients are mostly 15 – 30 years of age. PCOS include

17

chronic non – ovulation and hyperandrogenism associated with normal or raised

oestrogen, raised LH and low FSH/LH ratio.10

Approximately 25% of women will have ultrasound evidence of polycystic

ovaries. However not all these women will have symptoms that constitute PCOS. In

addition not all women with clinical features have ultrasound evidence of polycystic

ovaries.11

Aetiology: The exact aetiopathogenesis is unknown. But some endocrine disorders are

identified as:

1. Ovarian enlargement.

2. Hypothalamus – pituitary dysfunction where LH: FSH is 3:1 (normal is 1:1).

3. Exaggerated adrenal function.

4. Insulin resistance.10

Oestrogen, progesterone and androgen normally produced by the ovaries are

chemically interchangeable, androgens being intermediate products in the biosynthesis of

oestradiol. PCOS is the best example for ovarian anomalies with abnormalities in

hormone production and are associated with amenorrhoea.12

The fundamental pathophysiological process underlying PCOS remains uncertain.

However increasing evidence points towards the role of both insulin hyper secretion and

insulin resistance particularly in females, who are overweight or have associated

menstrual disturbance. It is most likely that this insulin hyper secretion is responsible for

excessive androgen secretion from ovaries.11

18

PCOS is a familial condition, possibly autosomal dominant, with premature

balding being the male phenotype. It appears during adolescence and is thought to be

associated with increased weight gain during puberty. However, the polycystic ovary

genes have not yet been identified and the effect of environmental influences such as

weight changes and circulatory hormone concentrations and the age at which these occur,

is unknown.

Prior to puberty, there appear to be two periods increased ovarian growth. The

first is at adrenarche in response to the increased concentrations of circulating androgens

and the second just before and during puberty due to rising gonadotropin levels, the

actions of growth hormone and insulin – like growth factor 1 (IGF - 1) and insulin on the

ovary. It was found that obesity was associated with a significant increase in uterine and

ovarian volume. It was also found in a study that obese post – menarchal girls with

polycystic ovaries had larger uterine and ovarian volumes than obese post – menarchal

girls with normal ovaries. This can be concluded that obesity leads to hyperinsulinism,

which causes both hyperandrogenaemia and raised IGF – 1 level, which augments the

ovarian response to gonadotropins. This implies that obesity may be important in the

pathogenesis of polycystic ovaries but needs further confirmation.13

The hyperandrogenism and anovulation that accompany PCOS may be caused by

abnormalities in four endocrinologically active compartments:

1. Ovaries

2. The adrenal glands.

3. The periphery (fat)

4. The hypothalamus – pituitary compartment

19

In patients with PCOS, the ovarian compartment is the most consistent

contribution of androgens. Dysregulation of CYP 17, the androgen forming enzyme in

both the adrenals and the ovaries, may be one of the central pathogenetic mechanisms

underlying hyperandrogenism in PCOS.14

The ovarian stroma, theca and granulosa contribute to ovarian hyperandrogenism

and are stimulated by LH. Excess of inhibin is responsible for the high level of LH.

Inhibin is a non – steroidal water soluble protein secreted by the Graafian follicles. In

normal ovarian folliculogenesis, FSH and LH initiate secretion of oestrogen by Graafian

follicle. Oestrogen is responsible for secretion of inhibin in the graafian follicle which in

turn suppresses FSH but stimulates LH secretion.15

Hyper secretion of LH occurs in approximately 40% of women who have

polycystic ovaries. The risk of infertility and miscarriage is raised in these patients.

Several hypotheses have been suggested to explain this over secretion of LH. These

include increased pulse frequency of GnRH, increased pituitary sensitivity to GnRH,

hyperinsulinaemic stimulation of the pituitary gland and disturbance of the ovarian

steroid – pituitary feedback mechanism.13

LH relates to ovarian androgenic activity in PCOS in a number of ways and they

are:

Total and free testosterone levels correlate directly with LH levels.

The ovaries are more sensitive to gonadotropic stimulation, possibly as a result of

CYP17 dysregulation.

Treatment with a gonadotropic releasing hormone agonist effectively suppresses

serum testosterone and androstenedione levels.

20

Larger doses of GnRH agonist are required for androgen suppression than for

oestrogen suppression.

The increased testosterone levels in patients with PCOS are ovarian in origin. The

serum total testosterone levels are not more than twice the upper normal range (20 to 80

ng/dl). However in ovarian hyperthecosis, values may reach 200ng/dl or more.

High levels of androgen result in an increase in the peripheral production of

oestrogen and decrease in sex hormone binding globulin. This leads to an increased level

of free androgens to produce hirsutism and to be converted to oestrogen. There is also

anovualtion as a result of retarded follicular maturation. Another consequence of raised

oestrogen levels is the target organ effect on adipose tissue formation and endometrial

hyperplasia.

The adrenal compartment also plays a role in the development of PCOS. Although

the hyperfunctioning CYP17 androgen forming enzyme co exists in both the ovaries and

the adrenal glands, DHEAS is increased in only about 50% of patients with PCOS. the

hyper responsiveness of DHEAS to stimulation with ACTH, the onset of symptoms

around puberty and the observation that 17, 20 – lyase activation is a key event in

adrenarche have led to the concept of PCOS as an exaggerated adrenarche.

The peripheral compartment defined as the skin and the adipose tissue, manifests

its contribution to the development of PCOS in several ways:

The presence and activity of 5 α reductase in the skin largely determines the

presence or absence of hirsutism.

Aromatase and 17 β – hydroxysteroid dehydrogenase activities are increased in fat

cells and peripheral aromatization is increased with body weight.

21

The metabolism of oestrogens, by way of reduced 2 – hydroxylation and 17α –

oxidation is decreased.14

Leptin, a 167 amino acid peptide is secreted by fat cells in response to insulin and

glucocorticoid. Leptin is transported by a protein which appears to be the extracellular

domain of the leptin receptor itself. Leptin receptors are found in the choroid plexus, on

the hypothalamus and ovary and at many other sites. Leptin decreases the intake of food

and stimulates thermogenesis. Leptin also appears to inhibit the hypothalamic peptide,

neuropeptide Y, which is an inhibitor of GnRH pulsatility.

Leptin appears to serve as signal from body fat to the brain about the adequacy of

fat stores for reproduction. Thus menstrual cycle will only occur if fat stores are

adequate. Conversely, obesity is associated with high circulating concentrations of leptin

and this in turn might be a mechanism for hypersecretion of LH in women with PCOS.13

The hypothalamic – pituitary compartment also participates in aspects critical to

the development of PCOS:

An increase in LH pulse frequency is the result of increased GnRH pulse

frequency.

This increase in LH pulse frequency typically results in elevated LH and LH to

FSH ratio.

FSH is not increased with LH probably because of the synergistic negative

feedback of chronically elevated oestrogen levels and normal follicular inhibin.

About 25% of patients with PCOS exhibit elevated prolactin levels. The

hyperprolactinemia may result from abnormal oestrogen feedback to pituitary gland.14

22

Tonically elevated LH

Increased androgen production from the theca cells and stroma of the ovaries

Decrease SHBG (Sex Hormone Binding Globulin)

Increased unbound oestrogens and androgens

Pituitary sensitivity to GnRH is increased

Preferential increased production of LH, decreased production of FSH due to inhibin

Figure 6: Mechanism of PCOS

PATHOLOGY:

Macroscopically, the ovaries are often bilaterally enlarged with thick capsule. The

size may increase to 2 to 5 times the normal size. The surface may be lobulated but the

peritoneal surface is free of adhesions. A cross section of the surface of the ovary

discloses a white, thickened cortex with multiple cysts which often measures less than a

centimetre but mostly 0.5 to 1mm and at times upto 20mm. These cysts are localized

along the surface of the ovary giving a “necklace appearance” on ultrasound. These are

atretic follicles. Theca cell hyperplasia is seen which produces excess of testosterone.

Microscopically, the superficial cortex is fibrotic and hypercellular and may

contain prominent blood vessels. In addition to small atretic follicles, there is an increase

in the number of follicles with luteinized theca interna. The stroma may contain

luteinized stromal cells.15

23

Figure 7: Appearance of normal ovary and ovary with PCOS.

CLINICAL FEATURES: 14, 16

Oligomenorrhoea/ Amenorrhoea

Anovulatory infertility

Dysfunctional menorrhagia

Hirsutism: excess hair growth such as on face, chest, abdomen etc.

Figure 8: Hirsutism

Obesity

Acne, oily skin or dandruff

24

Acanthosis nigricans – it is considered as a marker for insulin resistance in hirsute

women. This thickened pigmented velvety lesion of skin is most often found in the vulva

and may be present on the axilla, on the nape of the neck, below the breast and on the

inner thigh. Women with severe insulin resistance sometimes develops hair, consisting of

hyperandrogenism, insulin resistance and acanthosis nigricans. These patients usually

have high testosterone levels (> 1.5ng/ml), fasting insulin levels of more than 25µg/ml

(normal - <20µg/ml) and maximal serum insulin responses to glucose level exceeding

300µg/ml (normal is < 150 µg/ml).17

Figure 9: Acanthosis nigricans

Skin tag or tiny excess flap of skin in the arm pits or neck area

Alopecia – male type of baldness

Male fat storage patterns – abdominal storage rather than standard female pattern

on thighs, hips and waist.

Mid cycle pain indicating painful ovulation – due to the enlargement and blockage

of the surface of the ovaries.

Impaired glucose tolerance.

25

Biochemical and metabolic changes:

Insulin resistance and hyperinsulinaemia

Elevations in circulating androgens, particularly free testosterone

LH/FSH ratio is raised – 3:1 (Normal 1:1)

Decreased FSH level

Raised LH values

Reduced Sex Hormone Binding Globulin (SHBG).14

Ultrasound features:

Enlarged ovaries, generally 2 to 5 times than the normal

Multiple cysts along the surface of ovaries giving a “necklace appearance”

Figure 10: Appearance of PCOS in Ultrasonography

Long term consequences:

Frank diabetes mellitus early in life.

Increased risk for glucose intolerance.

26

Dyslipidemia

Hypertension

Cardiovascular disease (coronary artery disease due to obesity and insulin

resistance.)

In chronic anovulatory patients with PCOS persistently elevated oestrogen levels

uninterrupted by progesterone increases the risk of endometrial carcinoma.

Risk of breast cancer (due to hyperestrogenic state).17

INVESTIGATIONS:

Ultrasonography – shows several subcapsular cysts along the surface of the ovaries

Raised testosterone, androstenedione and DHEAS

Elevated LH/FSH ratio

Elevated LH levels

Decreased sex hormone binding globulin

Increased fasting insulin levels

Low FSH level15

Diagnostic criteria:

National Institute of Health – National Institute of Child Health and Human Development

Conference on PCOS in April 1990 reached a consensus on the diagnosis of PCOS based

on certain defined major and minor criteria:

Major criteria:

Chronic anovulation

Hyperandrogenism

Clinical features of hyper androgenism

27

Exclusion of other etiologies

Minor criteria:

Insulin resistance (acanthosis nigricans as well as biochemical)

Perimenarchal onset of hirsutism and obesity

Elevated LH:FSH ratio

Ultrasonographic evidence of PCOS

Intermittent anovulation associated with hyper androgenism

Management:

A patient with PCOS may present to a clinician at different stages of her life.

During adolescence, she may present with menstrual irregularities, skin problems such as

hirsutism, acne or acanthosis nigricans. During the reproductive years she may present

with infertility. She may present in later part of her life with problems related to long

term sequelae of PCOS namely gynaecological cancer, diabetes or cardiovascular risk.

The management hence depends on her presenting complaint.14

The conventional method is watchful waiting. The patient waits and gets re –

examined in one to three months to see if the cyst has changed in its size. This is a

common treatment option for women who are in their childbearing years, have no

symptoms and have a fluid filled cyst. It also might be an option for post menopausal

women.

Weight loss of more than 5% of previous weight is important and will help in

restoring the hormonal milieu to some extent. Consumption of low carbohydrate diet is

important along with regular exercise. Cigarette smoking raises DHEA and

androstenedione levels and hence should be avoided.15

28

Surgery: 15

Surgery is reserved for those in whom:

Medical therapy fails

Hyperstimulation occurs

Use of GnRH analogues is a cost constraint.

Surgery includes two main procedures:

1. Laparascopy:

This is done under general anaesthesia. This procedure is done if the cyst is small

and looks benign on ultrasound. A very small incision is made above or below the navel

and a small instrument that acts like a telescope is inserted into the abdomen and the

surgery is done by visualising on a television like screen and the cyst is removed.

2. Laparatomy:

This procedure is done if the cyst is large and looks suspicious. This involves

making bigger incisions on the abdomen to remove the cyst. While the patient is under

general anaesthesia, the doctor is able to have the cyst tested to find out if it is cancerous.

If it is cancerous, the doctor may need to remove the ovary and the other neighbouring

tissues and lymph nodes.

Cosmetic treatment:

For reducing excess body and facial hair certain methods can be done like

bleaching, waxing, plucking or shaving by using hair removal cream. Facial hair can be

permanently removed by electrolysis and laser hair removal technique.

29

HOMOEOPATHIC APPROACH

Homoeopathy as a therapeutic method is primarily concerned with the morbid

vital process in the living process in the living organism, which are perceptibly

represented by the symptoms, irrespective of what caused them.

In defining the scope of homoeopathy it is necessary to discriminate between

diseases per se, as a morbid vital process and the material results or products in which the

morbid process ultimates. With the latter Homoeopathy has nothing to do. It is concerned

only with disease per se, in its primary, functional or dynamic aspect.18

Homoeopathy is a system of drug therapeutics based on law of similar. A

complete diagnosis offers a full comprehension of the patient personality, his constitution

and the mechanism and production of symptoms. (Subjective and objective), the

pathologic agent and the physiological disturbances induced the physiological

accompaniments and the pathogenesis. Homoeopathic remedies are prescribed by

symptoms rather than conditions, as each case of particular illness can manifest

differently in different people.19

The sickness of the person expresses itself at his various levels and to bring all

such expressions together to get a whole picture, requires a clear understanding of what

Hahnemann stated: “ What is to be cured in a disease, that is to say in every individual

case of disease.20

Homoeopathy very properly and ideally fits into the concept of holistic medicine.

A homoeopath has a psychosomatic approach to every patient and more particularly to

30

every chronic patient. He considers a patient as an individual; a single unit of mind and

body as against the analytical approach, which emphasizes the extrinsic factors.

Susceptibility is the individuals’ capacity to react to stimulus. Dr Kent calls it as

influx of flow. Every individual has different susceptible levels which vary according to

the age, sex and other factors. In contagion (and consequently in cure) there is practically

but one dose administered, or at least that which is sufficient to cause a suspension of

influx. When cause ceases to flow in a particular direction it is because resistance is

offered for causes flow only in the direction of least resistance and so when resistance

appears influx ceases, the cause no longer flow in.21

“One man’s meat is another man’s poison”. Susceptibility can be increased,

decreased or destroyed. It therefore becomes a state of lowered resistance or attraction.22

Disease comes about only when two conditions are fulfilled, the presence of an external

morbific agent and the patient’s own susceptibility. It is not merely the result of exposure

to a number of microbial invaders. That is why an epidemic never hits everybody in a

particular area.

Dr Kent writes: “They will tell that the bacillus is the cause of tuberculosis. But if

man had not been susceptible to the bacillus he could not have been affected by it. The

bacteria are results of the disease; the microscopical little fellows are not the disease

cause, but they come after. They are the outcome of the disease, are present wherever the

disease is and by the microscope it has been discovered. The old school considered these

the cause; but the cause is much more subtle than anything that can be shown by a

microscope”.23

31

In analyzing susceptibility, we find it is very largely an expression of a vacuum in

the individual. This is illustrated by the desire for food. The vacuum attracts and pulls for

the things most needed, that are on the same plane of vibration as the want in the body.24

Suppression is another concept which is believed and followed by homoeopathy.

It is the forceful removal of the symptoms without doing anything for the cure. There

are external forces which may have an impression upon the vital energy, yet that allow

it to work in undisturbed harmony and there are external forces that have great influence

in inhibiting its normal functioning.22

When the normal function is inhibited the immediate reaction is a lack of

harmony and a warped and suppressed functioning of the vital force, so that disease

conditions are produced with the attendant symptoms and irregular functions of the body.

Such conditions as shell-shock, fright, fear, excessive joy, unrequited love, grief etc can

cause suppression. Suppression can even result from attempts to suppress the natural

secretions of the body. A frequent form of suppression is the removal of disturbing

organs by surgical means, again forbidding the expression of the vital force through its

chosen organs by doing this we are cutting off the manifestation of disease and are doing

nothing to set in order the vital energy or to prevent further disease manifestations. These

diseased conditions have developed as an expression of the inward turmoil and distress

under which the whole individual suffers. Suppression is the source of many functional

disturbances.

The homoeopathic physician is the only physician who is equipped to deal with

these conditions, for his province and the fundamental principle of his work is the proper

co-ordination and normal functioning of the body, the mind and the spirit; and it is only

32

when the three spheres of man co-ordinate to develop in their normal way that harmony

and health can be maintained and preserved.22

The suppressed case always goes bad. PCOS is one of those diseases which arise

as a result of such suppressions especially when there is suppression at the mental level

and also due to suppression of menses with the help of hormonal tablets. So this cause of

suppression also helps in selection of a correct remedy

The totality of symptoms is intended to be a curative indication; and if disease is

to be cured, it should be taken as early as possible. In such early stages maladies are often

recognizable by rational signs alone and mainly by symptoms of a subjective nature. This

point has been made by Caroll Dunham in his essay entitled “The Relation of Pathology

to Therapeutics”. To base therapeutics upon pathology the former is merely palliative – a

pumping out a leaking ship instead of stopping the leak.24

Since cause continues into ultimates and things in ultimates shadow forth cause,

the removal of all the symptoms will lead any rational man to assume that the cause has

been removed. This will lead us to see that if a large number of symptoms manifest

themselves through a diseased ovary, and that ovary is removed the cause of the

symptoms has not been removed and will manifest itself through some other part of the

body, perhaps the other ovary or some organ that is weak.

The "totality of the symptoms" means a good deal. It is a wonderfully broad thing.

It may be considered to be all that is essential of the disease. It is all that is visible and

represents the disease in the natural world to the eye, the touch and external

understanding of man. It is all that enables the physician to individualize between

diseases and between remedies; the entire representation of a disease is the totality of the

33

symptoms, and the entire representation of a drug is the totality of the symptoms. It does

not mean the little independent symptoms, but it means that which will bring to the mind

a clear idea of the nature of the sickness.21

According to aphorism 6 “The unprejudiced observer - well aware of the futility

of transcendental speculations which can receive no confirmation from experience - be

his powers of penetration ever so great, takes note of nothing in every individual disease,

except the changes in the health of the body and of the mind (morbid phenomena,

accidents, symptoms) which can be perceived externally by means of the senses; that is to

say, he notices only the deviations from the former healthy state of the now diseased

individual, which are felt by the patient himself, remarked by those around him and

observed by the physician. All these perceptible signs represent the disease in its whole

extent, that is, together they form the true and only conceivable portrait of the disease”.25

A homoeopathic physician requires sufficient tact and a mastery of the technique

of case taking in order to obtain all the detailed information about the patient and

individual which helps in finding the constitution of the patient. Thus the totality of

symptoms which include mental generals, physical generals and characteristic particulars

or uncommon symptoms taken in the patient suffering from a disease helps in better

selection of medicine and rapid and permanent cure rather than going by the disease

name.

Homoeopathy recognizes the individuality of each patient or case. The entire

examination of a patient is conducted with a view to discovering not only the general or

common features of the case by which it may be classified diagnostically and

pathologically, but the special and particular symptoms which differentiate the case from

34

others of the same general class. It recognizes the fact that no two cases or patients, even

with the same disease, are exactly alike, and maintains that a true science of therapeutics

must enable the practitioner to recognize these differences and find the needed remedy

for each individual. In actual practice the "differences" are very often the deciding factor

in the choice of the remedy. To use a frequently quoted epigram: "Homoeopathy does not

treat disease. It treats patients." In one word, it individualizes. It may be added that

homoeopathy is the only method by which the prescriber is able to thus individualize his

medication.18

Individualization can be elicited in many different ways like variation in

expression, variation in pace of disease, miasm or pathological changes. Thus patients

suffering from PCOS can also be individualized based on the presentation as one may

present with hirsutism or infertility or obesity and so on and also on the basis of dominant

miasm and the extent of pathological changes and last but not the least on the basis of

mental and physical generals.

MIASMATIC APPROACH:

In his observation of cases, and in the further study of the progress of diseased

conditions under the homoeopathic method of treatment, Dr Hahnemann was especially

struck with the course of non-venereal diseases. Dr Hahnemann found himself treating

seemingly acute conditions with apparent success, but, to his surprise, these cases would

return with a recurrence of symptoms at intervals; sometimes these symptoms were very

similar to those they had had before, while at other times there would be an aggravation

of the previous condition, or other variations. Considerable study of these cases

35

convinced Dr Hahnemann that there was some underlying condition which was the

mainspring of these recurrent manifestations. To these he gave the term miasm.22

Miasms are the foundation of all the chronic diseases. The fact is we cannot select

the most similar remedy possible unless we understand the phenomena of the acting and

basic miasms; for the true similima is always based upon the existing miasms, whether

we are conscious or unconscious of the fact.

The morbific agents that are casually connected with the production of disease

were designated by a general term miasm/miasma by Dr Hahnemann by the word

miasma he meant a defect in the constitution which was an obstacle for recovery and the

medicine given to remove the miasmatic block is called as antimiasmatic remedies.

According to Dr Hahnemann’s classification of disease, PCOS is a

multimiasmatic disease with predominantly psora and sycosis in the background. Because

according to the aetiology of PCOS, neuro – endocrine disturbance is attributed to psora,

but the menstrual irregularities, hirsutism, infertility and according to the pathology

which predominately consists of cysts comes under sycotic. The miasm is psoro – sycotic

but it can vary in different cases.26

The attempt to suppress the sycotic manifestation especially the discharges, is

very common but suppressive measures meet with a very prompt and decided renewal of

the stigmatic power and energy. After such an attempt, the destructive progress of the

disease becomes much more rapid and often leads to malignancies. This is very often

seen in the disturbances of the sexual organs. The sycotic miasm mainly targets the uterus

and reproductive organs. Many of the ovarian or tubercular symptoms that develop

during menses are dependent more on Sycosis than any other miasm. In more chronic

types we get cystic degeneration of the ovaries, the uterus and the fallopian tubes.27, 28

36

HOMOEOPATHIC THERAPEUTICS:

PCOS is a condition which does not have an external cause but it is a dynamic

disease which requires treatment from within. So a deep acting polychrest remedy is

utmost required which is otherwise called as constitutional medicine. But there are still

some medicines which have specific action on ovarian cysts and called as specific

remedy. Any polychrest deep acting medicine can become a constitutional remedy for a

patient, depending upon the totality. These include medicines like Apis, Lachesis, Platina,

Pulsatilla, Sepia, Natrum mur, Calc carb, Graphities, Nux vom, Phosphorus,

Lycopodium, Aurum met, Staphysagria, Kali carb etc. Some of them are listed below.

Apis mellifica: Ovarian cysts in their incipiency have been arrested by this remedy; here

one of the indicating features is numbness down the thigh. Mainly affects the right ovary

but has also proved useful in affections of left ovary.29 Its value in ovarian cysts, for

which it has been recommended, is more than doubtful. It has been used for pains

occurring in right ovarian region.30 The flow of blood is scanty, dark and mixed with

mucus. Amenorrhoea attended with congestion to the head. Menses suppressed with

cerebral and head symptoms, especially in young girls. Amenorrhoea especially during

puberty. Concomitants are irritable disposition, jealous, very busy, restless, constantly

changing her occupation. Awkwardness. No thirst with dryness of mouth and throat.

Ovarian disease especially on right side with a tendency to dropsy. Ovarian tumours

attended with the peculiar stinging pains.31

Apocynum cannabinum: Amenorrhoea in young girls or dropsical extension of

abdomen and extremities32, metrorrhagia with nausea; fainting, vital depression.

37

Haemorrhages at change of life. Blood expelled in large clots. Apocynum patients will

be very bewildered, nervous and low spirited.33 Metrorrhagia: continued or paroxysmal

flow; fluid or clotted; pulse quick, feeble, when moved.32 Generally worse, cold weather;

cold drinks; uncovering.33

Argentum nitricum: Painful affections of left ovary. Bleeding easily. Uterine

haemorrhage two weeks after menses (metrorrhagia). Gastralgia at the beginning of

menses. Leucorrhoea profuse, with cervical erosion.33 Menses irregular; scanty (with

asthma). Menses too copious or too scanty, too soon or too late. All symptoms agg.

before and during menses. Metrorrhagia, with nervous erethism at change of life; also in

young widows and those who have borne no children; returning in attacks, region of

ovaries painful, with pains radiating to sacrum and thighs.34 Adapted to the dried

withered and haggard look, the general emaciation especially of the lower limbs and the

peculiar nervous mental state are features too striking. Argentum patient is in constant

hurry, fearful lest delay will spoil everything. Apprehension when ready for church or

opera, diarrhoea sets in. The Argentum nitricum patient is extremely sad, gloomy, and

taciturn. Another key-note feature of this remedy is flatulence. The wind rumbles in the

abdomen which the patient finds hard to expel. The patient craves sugar; but diarrhoea

results from eating.32, 34 Generally worse from warmth in any form; at night; from cold

food; sweets; at menstrual period; from emotions, left side. Better from eructation; fresh

air; cold and pressure.33

Arsenicum album: Right sided affection. Menses too profuse and too soon. Burning in

ovarian region. Leucorrhoea, acrid, burning, offensive, thin. Pain as from red-hot wires;

worse least exertion; causes great fatigue; better in warm room. Menorrhagia. Stitching

38

pain in pelvis extending down the thigh.33 Arsenic patients are highly restless both

mentally and physically, with depression, melancholy, irritability and marked anxiety.

Anxious fear of death; thinks it is useless to take medicine, is incurable, is surely going

to die; dread of death, when alone, or, going to bed. Attacks of anxiety at night driving

out of bed, < after midnight. Burning thirst without special desire to drink; the stomach

does not seem to tolerate, because it cannot assimilate cold water; lies like a stone in the

stomach. It is wanted, but he cannot or dare not drink it. Great thirst for cold water;

drinks often, but little at a time; eats seldom, but much. Rapid emaciation, with cold

sweat and great debility. Excessive exhaustion from least exertion.33, 34 Generally worse

in wet weather, after midnight; from cold, cold drinks, or food at seashore, right side.

Better from heat; from head elevated; warm drinks.33

Aurum iodatum: A remedy for cysts ovarian cysts and fibroid of uterus. Ovarian cysts

especially affecting the right ovary. Induration and inflammation of the ovaries. Menses

absent; copious; late; suppressed. Sterility. Pain in ovaries. Strong desire for open air and

feels better in open air. Exertion increases all the complaints. Anxiety day and night.

Spells of unusual cheerfulness. Aversion to company. Want of self-confidence. Despair

of her salvation and of recovery. Fear of evil and of people. Indolence. Mental

prostration. The patient has increased and ravenous appetite. Desires alcoholic stimulants.

Thirst, burning and extreme. Leucorrhoea is acrid, copious, thick and yellow.35

Aurum muriaticum natronatum: Induration of ovaries with dropsy. Enlargement of

ovaries.36 Atonic amenorrhoea, scanty and delayed menses. It is very useful in chronic

and sub-acute indurations of the womb and ovary and in chronic suppurations of the

glands and bones. This remedy works better in mercuro-syphilitic constitutions. The most

39

important symptom of this remedy, however, is boring pain felt all over the body but

mostly in the skull, tibia and other bony structures of the human system. These pains are

invariably worse in the cold wet weather. The organ, however, that suffers mostly is the

uterus and its appendages. Enormous distension of the ovary with corroding leucorrhoea

has been helped with this remedy. Leucorrhoea, with spasmodic contraction of vagina. It

is particularly useful in sub-acute metritis, ovaritis, endo-cervicitis and ulceration of

uterus.33

Baryta muriaticum: One symptom particularly characteristic of Baryta mur is the

irritation it causes and hence cures in the female sexual system.37 Pains, as from a bruise,

in the cavity of the pelvis. Leucorrhoea. Induration, tumour or atrophy of ovaries.

Nymphomania. Great anxiety, with gastralgia, nausea, and retching; has to bend double.

Idiocy. Mania of every form as soon as sexual desire is increased.34 Menses copious, too

often, painful, sterility.35 The patient writhes in agony and rolls on the floor with attacks

of anxious dyspnoea.37 Its complaints are prominent in the morning, forenoon, afternoon,

evening, night and after midnight. The patient desires the open air, yet the open air often

increases the symptoms. Extreme lassitude, compelled to lie down. Symptoms come

before and during menses. Some symptoms are better from motion; bruised feeling

internally; burning in many parts; cutting pains in internal parts; digging pains are not

uncommon; gnawing in external parts. Complaints left sided. Easily angered, anxiety in

the evening.35

Bovista: Ovarian cyst; soreness between labia and thighs; every few days a show

between menses; after midnight painful urging towards genitals, with great heaviness in

small of back, amel. next morning by a bloody discharge.36 Diarrhoea before and during

40

menses. Voluptuous sensation. Leucorrhoea acrid, thick, tough, greenish, follows menses.

Cannot bear tight clothing around waist. Soreness of pubes during menses. Metrorrhagia;

Parovarian cysts.33 Menses: flow only at night; not in the daytime; occasional show every

few days between period; every two weeks, dark and clotted; with painful bearing

down.32 Bovista corresponds to a certain type whom circumstances of life have made

intensely awkward and ill at ease. This awkwardness is manifested by a constant

tendency to drop things. This is partly due to weariness and weakness of joints and partly

to intense nervousness. Another peculiarity with these patients is that they are somewhat

bloated. They are more or less puffy, and the integument about them is somewhat

velvety. Sensation of enlargement - a feeling of hugeness. The ovaries feel too large; the

uterus seems enormous.37

Calcarea carbonicum: Menses too early, too profuse, too long, with vertigo, toothache

and cold, damp feet. Uterus easily displaced. Leucorrhoea, milky. Burning and itching of

parts before and after menstruation; in little girls. Sterility with copious menses.33 The

least mental excitement causes profuse return of menstrual flow. It is especially adapted

to the leuco-phlegmatic, blond hair, light complexion, blue eyes, fair skin; tendency to

obesity in youth.32 They are corpulent and unwieldy. Head sweats profusely wetting the

pillow far around which smells sour. The five F’s of Calc are Fair, Fatty, Flabby, Fatigue

and Fear. Apprehensive and anxious. Obstinate. General and local coldness. Slow and

sluggish in all activities. Solitude is insupportable. Disgust and aversion to all labour

whatever. Great weakness of memory and of conception, with difficulty in thinking.

Tendency to make mistakes in speaking, and to take one word for another. She fears she

will lose her understanding, or that people will observe her confusion of mind.38, 41 Chilly

41

patient. Generally worse, from exertion, mental or physical; ascending; cold in every

form; water, washing, moist air, wet weather; during full moon; standing. Better, dry

climate and weather; lying on painful side.33

Cantharis: Cysto ovarium, much tenderness and burning in ovarian region.36 Menses too

early and too profuse. Burning pain in ovaries; extremely sensitive.33Corrosive

leucorrhoea, with burning sensation on making water, and excitement of sexual desire.34

Over sensitiveness of all parts. Disgust for everything; drink, food, tobacco.32

Cimicifuga racemosa: Amenorrhoea. Pain in ovarian region; shoots upward and down

anterior surface of thighs. Pain immediately before menses. Menses profuse, dark,

coagulated, offensive with backache, nervousness; always irregular. Ovarian neuralgia.

Pain across pelvis, from hip to hip.33 During menses the patient becomes hysterical or

suffers from epileptic spasms. The mental symptoms, undergo strange aberrations and

aggravations during this period. It is a great remedy for reflex pain; we use it in sharp

lancinating electric like pains in various parts of the body when in sympathy with ovarian

irritation or due to reflex from uterus. This patient is sad and morose. There is a great

abundance of sighing. Mental depressions sometimes take the form of suicidal mania.37

Mania following disappearance of neuralgia. Sensation as if a heavy, black cloud had

settled all over her and enveloped her head so that all is darkness and confusion. Illusion

of a mouse running from under her chair.32 Generally worse in morning, cold, during

menses, the more profuse the flow, the greater the suffering. Better, warmth.33

Colocynthis: Ovarian cysts with pain in abdomen upon straightening up; walks bent with

hands pressed upon painful side. Suppression of menses from indignation.36 Round, small

cystic tumors in ovaries or broad ligaments. Wants abdomen supported by pressure.

42

Boring pain in ovary. Must draw up double, with great restlessness.33 Agonizing pain in

abdomen causing patient to bend double, with restlessness, twisting and turning to obtain

relief >> by hard pressure. Pains: are worse after eating or drinking; compel patient to

bend double; menses, suppressed by chagrin, colic pains.32 Extremely irritable. Becomes

angry when questioned. Mortification caused by offense. Anger, with indignation.33

Conium maculatum: Induration or enlargement of ovaries with lancinating pains in

ovarian region, extending through whole lower part of abdomen. Ovarian affections with

amenorrhoea and ill-effects of suppressed sexual instinct. Sterility.36 Ovaritis; ovary

enlarged, indurated. Ill effects of repressed sexual desire or suppressed menses, or from

excessive indulgence. Leucorrhoea after micturition. Associated with glandular

enlargements.33 Catamenia premature and too weak. Suppression of catamenia. Before

the catamenia, pains in the breasts; anxious dreams, dry heat, pain as from fatigue in the

limbs, lachrymose humour, and hepatic pains. During the catamenia, sensation of bearing

down and dragging in the thigh, or painful cramps in the abdomen. Suppressed

menstruation. Burning, acrid, corrosive, and pungent leucorrhoea, accompanied or

preceded by colic. Breasts flabby.34 It is generally indicated in persons of lively, quick,

sanguinous disposition with a marked development of the glandular system.37 Generally

worse, lying down, turning or rising in bed; celibacy; before and during menses, from

taking cold, bodily or mental exertion. Better, while fasting, in the dark, from letting

limbs hang down, motion and pressure.33

Graphites: Menses too late, with constipation; pale and scanty, with tearing pain in

epigastrium, and itching before. Induration of ovaries and uterus and mammae.

Leucorrhoea, pale, thin, profuse, white, excoriating, with great weakness in back.

43

Decided aversion to coitus.33 It has cured cases of ovarian cysts. Suited to women,

inclined to obesity, who suffer from habitual constipation; with a history of delayed

menstruation.32 The mental depression is extreme, and it is made worse by music; her

sadness is so great that she thinks only of death and salvation. Grief and vexation cause a

recurrence of all her distressing mental sufferings. Her moods are constantly changing;

while she may recall all the events of youth, recent events are forgotten; slow of thought

and weakness of mind worse in the morning; often excited, hurried and exhilarated in the

evening; extremely fretful and impatient; irritable about trifles and very critical.

Irresolution is a marked symptom. She cannot make up her mind to do or not to do.35

Generally worse, warmth, at night, during and after menstruation. Better, in the dark,

from wrapping up.33

Ignatia amara: Menses, black, too early, too profuse, or scanty. During menses great

languor, with spasmodic pains in stomach and abdomen. Feminine sexual frigidity.

Suppression from grief.33 Catamenia premature and violent, every ten or fifteen days.

Blood of the catamenia black, of putrid odour, mixed with clots. Metrorrhagia.34 The

Ignatia patient nurses her sorrows, keeping them from others, melancholy with weeping.

Nervous women who are burdened with grief, particularly when they dwell upon their

troubles in secret.38 Especially suited to nervous temperament; women of a sensitive,

easily excited nature; dark hair and skin but mild disposition, quick to perceive, rapid in

execution. Mental conditions rapidly, in an almost incredibly short time, change from joy

to sorrow, from laughing to weeping; moody. Desire to be alone. Finely sensitive mood,

delicate consciousness. Inconstant, impatient, irresolute, quarrelsome. The slightest fault

finding or contradiction excites anger, and this makes her angry with herself. Ill effects,

44

from bad news; from vexation with reserved displeasure; from suppressed mental

sufferings; of shame and mortification.32 Generally worse, in the morning, open air, after

meals, coffee, smoking, liquids, external warmth. Better, while eating, change of

position.33

Iodum: Amenorrhoea. Many cases of ovarian cysts.39 Indurations and swelling of uterus

and ovaries. Wedge like pain from ovary to uterus.33 Pain in ovaries and back during

menses. Ovarian cyst and dropsy. Irregular menses delayed for eight days. Chronic

amenorrhoea of long standing duration.34 Persons of a scrofulous diathesis, with dark or

black hair and eyes; ravenous hunger; eats freely and well, yet loses flesh all the time.34

Great weakness during menses. Menstruation irregular. Uterine haemorrhage. Ovaritis.

Acrid leucorrhoea, thick, slimy, corroding the linen. Complaints affecting right side.

Generally worse, when quiet, in warm room, right side. Better, walking about, in open

air.33

Jonosia ashoka: Has an extensive action on female organs. Delayed and irregular

menses. Amenorrhoea and metrorrhagia. Pain in ovaries before flow; menorrhagia,

irritable bladder; leucorrhoea.33 Thirsty, excessive nausea; obstinate constipation;

haemorrhoids. Gastric; Desire for sweets, also acid things.

Kali bromatum: Ovarian tumour. Several cases of cystic tumours of the ovary or broad

ligament. Ovarian neuralgia with great nervous sensitiveness.39 Complaints associated

with acne of face with extreme itching. Adapted to large persons who are fleshy.32

Exaggerated sexual desire. Sterility from excessive sexual indulgence. Abolition of all

sexual feeling during coition. Menorrhagia from ovarian irritation caused by strong

sexual desire. Aversion to coition; menses scanty.34 General failure of mental power, loss

45

of memory, melancholia, anaesthesia of the mucous membranes, especially of eyes,

throat, and skin; acne; loss of sexual desire, paralysis. Great depression of mind. The

patient is very fretful, crying at trifles and constantly brooding. These fits of crying

sometimes become almost uncontrollable. The melancholy is so profound that the patient

weeps constantly and nothing relieves the remarkable depression of mind. This

depression partly owes its origin to a great despondence - a despondence that almost

drives him mad and makes him very apathetic. Another trait is a great suspicion of mind.

She imagines that she will be poisoned; that she is pursued by some evil spirits; that she

is hated by everybody or that her honour is at stake.37 There is one symptom which is

valuable as a "guiding symptom," viz.: “fidgety hands”. The patient must be working or

playing with them continually; even the sleeplessness is somewhat relieved by moving

the fingers over the bed clothes; or he plays with his watch chain or the head of his cane,

anything to work off this excess of nervousness.40

Kali carbonicum: Delayed menses in young girls. Difficult first menses. Amenorrhoea.

Menses early, profuse or too late pale and scanty with soreness about genitals; pains from

back pass down through gluteal muscles, with cutting in abdomen. Uterine haemorrhage;

constant oozing after copious flow, with violent backache, relieved by sitting and

pressure. Pain through left labium, extending through abdomen to chest.33 Suppression of

menses with anasarca and ascites.34 Feels badly, week before menstruation: backache,

before and during menses.32 It is a polychrest of very high repute and is applicable to

elderly people with lax fibre and dark hair. A great tendency towards obesity is noticed in

these patients. They are fleshy and flabby.37 Suppression of menses with sour eructations

and swelling of cheeks at every menstrual nisus, shooting pains over the abdomen,

46

anaemic and weak heart; swelling over eye lids. Often brings on menses when Nat m

fails.41 The patient is whimsical, irascible, and irritable to the very highest degree,

quarrels with his family and with his bread and butter. He never wants to be alone, is full

of fear and imaginations when alone, "fear of the future, fear of death, fear of ghosts".

Over sensitive to everything, sensitive to every atmospheric change. The patient does not

seem to care for anything. This indifference is associated with great bodily exhaustion.

When questioned, the patient, usually a female, does not seem to know exactly what to

say or what she wants.38 Despondent. Alternating moods. Anxiety felt in stomach. Never

wants to be left alone. Obstinate and hypersensitive to pain, noise, touch. Generally the

patient is worse, after coition; in cold weather; from soup and coffee; in morning about

three o'clock; lying on left and painful side. Better, in warm weather, though moist;

during day, while moving about.33

Lachesis: Complaints especially of left ovary. Pain in left ovarian region, increasing

more and more until relieved by a discharge of blood. Swelling, pain and other anomalies

of the left ovary. She cannot bear any pressure around the waist.31 Diarrhoea before

menstruation is another lachesis indication.30 Menses too short, too feeble. Pains all

relieved by the flow. Left ovary very painful and swollen, indurated.33 Pains from ovaries

to uterus, with discharge of pus while at stool. Catamenia feeble, tardy, and of too short

duration, often accompanied by haemorrhoidal and other sufferings. Menstruation

suppressed. Menstrual colic, beginning in left ovary. Menstruation too scanty.34 Persons

of a less melancholy temperament, dark eyes, and a disposition, low spirits and indolence.

Women of choleric temperament, with freckles and red hair. Better adapted to thin and

emaciated than to fleshy persons; to those who have been changed, both mentally and

47

physically, by their illness.32 Great sensitiveness that they cannot bear any tight clothing.

Lachesis is a very valuable remedy at the climaxis, especially in the woman who has

exhausted herself by frequent pregnancies and hard work. In this worn-out condition

there occurs a sudden cessation of the menses. Suppression or non-appearance of

discharges always makes the Lachesis patient worse. The patient is nervous, anxious,

jealous, loquacious, jumping from subject to subject; suspicious, sometimes with fear of

being poisoned.38 Hot patient. The symptoms of Lachesis are worse on entering sleep.35

Generally worse, after sleep,; ailments that come on during sleep; left side, in the spring,

warm bath, pressure or constriction, hot drinks; Closing eyes. Better, appearance of

discharges, warm applications.33

Lilium tigrinum: Menses normal as to time and quantity but flows only when the patient

is moving about. Scanty and thick flow. Amenorrhoea accompanied with ovarian

affections. Secondary or partial amenorrhoea.31 Amenia with heart affections, together

with prolapsed or retroversion. Burning, stinging pain in the ovaries; partial amenia with

occasional return of menses and absent again; pain in the chest from left nipple through to

the back.41 Menses early, scanty, dark, clotted, offensive; flow only when moving about.

Bearing down sensation with urgent desire for stool, as though all organs would escape.

Ceases when resting. Congestion of uterus, prolapse and anteversion. Constant desire to

support parts externally. Pain in ovaries and down thighs. Acrid, brown leucorrhoea;

smarting in labia. Sexual instinct awakened. Bloated feeling in uterine region. More

often indicated in unmarried women. Adapted to reflex states dependent on some

pathological condition of the uterus and ovaries. Tormented about her salvation,

consolation<. Profound depression of spirits. Constant inclination to weep. Anxious;

48

fears some organic and incurable disease. Disposed to curse, strike, think obscene things.

Aimless, hurried manner. must keep busy. Generally worse consolation, warm room.

Better, fresh air.33

Lycopodium clavatum: Menses too late; last too long, too profuse. Vagina dry. Coition

painful. Right ovarian pain. Leucorrhoea, acrid, with burning in vagina. Discharge of

blood from genitals during stool.33 Amenorrhoea from fright. Sad and weeping; acid

eructation and vomiting; desires sweet things; rumbling of the abdomen; wind passes

from vagina with a noise.41 For persons intellectually keen, but physically weak; upper

part of body emaciated, lower part semi-dropsical; predisposed to lung and hepatic

affections. Ailments from fright, anger, mortification, or vexation with reserved

displeasure. Avaricious, greedy, miserly, malicious, pusillanimous. Irritable; peevish and

cross on waking; ugly, kick and scream; easily angered; cannot endure opposition or

contradiction: seeks disputes; is beside herself. Weeps all day, cannot calm herself; very

sensitive, even cries when thanked. Dread of men; of solitude, irritable and melancholy;

fear of being alone. Complexion pale, dirty; unhealthy; sallow, with deep furrows, looks

older than she is; fan-like motion of alae-nasi.32 Has aversion to undertaking anything

new, aversion to appearing in any new role, aversion to own work. Religious insanity.

They are far from being self-possessed. Extremely sensitive, they take offence at trifles

and are easily excited to anger. They are discontented, impatient and misanthropic.35 Hot

patient. Generally Worse, right side, from right to left, from above downward, 4 to 8 p.m.

from heat or warm room, hot air, bed. Warm applications, except throat and stomach

which are better from warm drinks. Better, by motion, after midnight, from warm food

and drink, on getting cold, from being uncovered.33

49

Magnesium carbonica: Suppression of menses with sore – throat and toothache at every

menstrual nisus.41 Before menses, coryza and nasal stoppage. Menses too late and scanty,

thick, dark, like pitch; mucous leucorrhoea. Menses flow only in sleep; more profuse at

night, or when lying down; cease when walking.33 Menstrual flow more profuse during

night than day; with dragging pains, >> from pressure on abdomen and stooping.

Catamenia retarded, or completely suppressed; too scanty; or premature, and

accompanied by a variety of sufferings. Constant headache, at each excessive menstrual

period. During catamenia : dejection, shivering, pains in head, paleness of face, pains in

loins, and cramp-like, pressive pains in abdomen, which arrest the menstrual flow.34

These patients are extremely sensitive both bodily and mentally. The slightest touch

causes startling; the slightest noise irritates; the slightest pressure aggravates almost all

symptoms and the slightest exposure to draughts of cold air brings on untold miseries. It

is a sycotic remedy. The Magnesium feeling is that the person doesn't get the care,

protection and nourishment that she needs. Dependent for care, nourishment, security and

support. There are repressed emotions that can be manifested in the form of a tremendous

causeless anxiety, especially anxiety or fear that something will happen to the people the

patient is close to. Their repressed emotions can also be expressed in the form of dreams.

Chilly patient.42

Medorrhinum: Sycotic miasm. For the constitutional effects of maltreated and

suppressed gonorrhoea, when the best selected remedy fails to relieve or permanently

improve. For women, with cysts, and other morbid ovaries with or without sycotic

origin.32 When the best selected remedy fails to remove or permanently improve this

50

remedy can be given as an inter current. Chronic pain in left ovary with enlarged

ovaries.35 Sycotic sterility.43 Intense pruritus. Menses offensive, profuse, dark, clotted;

stains difficult to wash out, urinates frequently at that time. Sensitive spot near os uteri.

Leucorrhoea thin, acrid., excoriating, fishy odour. Sycotic warts on genitals. Ovarian

pain, worse left side, or from ovary to ovary. Sterility. Metrorrhagia. Intense menstrual

colic.33 Weakness of memory; constantly loses the thread of conversation. Great

difficulty in stating her symptoms, question has to be repeated as she loses herself.

Anticipates death. Anxious, nervous, extremely sensitive; starts at the least sound. Time

passes too slowly. Is in a great hurry; when doing anything is in such a hurry she gets

fatigued. Many symptoms are < when thinking of them.32 Generally Worse, when

thinking of ailment, from daylight to sunset, heat, inland. Better, at the seashore, lying on

stomach, damp weather.33

Natrum muriaticum: Anxious and melancholy at the menstrual nisus; nausea with flow

of sweet saliva, spitting of blood; long lasting headache in morning on waking;

constipation, fissures of the anus. Followed well by Kali carb.41 Menses irregular; usually

profuse. Vagina dry. Leucorrhoea acrid, watery. Bearing-down pains; worse in morning.

Prolapsus uteri, with cutting in urethra. Suppressed menses. Hot during menses.33 Before

catamenia, moroseness and irritability. At commencement of catamenia, sadness. During

catamenia, cramps in abdomen. Acrid and greenish leucorrhoea.34 Psychic causes of

disease; ill effects of grief, fright, anger, etc. Depressed, particularly in chronic diseases.

Consolation aggravates. Irritable; gets into a passion about trifles. Awkward, hasty.

Wants to be alone to cry. Tears with laughter.33 Great emaciation; losing flesh while

living well. For the anaemic and cachectic; from loss of vital fluids.32 Worse, noise,

51

music, warm room, lying down about 10 a. m; at seashore, mental exertion, consolation,

heat, talking. Better, open air, cold bathing, going without regular meals, lying on right

side; pressure against back, tight clothing. Unquenchable thirst. Sweats while eating.33

Great dryness of mucous membranes from lips to anus; lips dry and cracked, especially in

the middle; anus dry, cracked, fissured; constipation. Tongue; mapped with red muscular

patches.40 The skin is shiny, pale, waxy, looks as if greased. Unrequited affection brings

on complaints. She is unable to control her affections and falls in love with a married

man. Over sensitiveness.35 Craving for salt, great aversion to bread.32 Hot patient.

Nux vomica: Menses too early, lasts too long; always irregular, blood black with faint

spells. Prolapsus uteri. Dysmenorrhoea, with pain in sacrum, and constant urging to stool.

Desire too strong. Metrorrhagia, with sensation as if bowels wanted to move.33 Return of

catamenia at the period of full moon. Menses excessive, with much vaginal irritation.34

They are always in the front rank of all enterprises and in consequence they generally

occupy the topmost places in all occupations and all departments of life. They are thin,

irritable, choleric persons with nervous, melancholic temperament. It is thus suited to

careful and zealous persons, to people who are over-cautious, intellectual and irritable in

their disposition. The irritability of Nux knows no bounds. Over sensitive to all external

impressions.37 Anxiety with irritability and inclination to commit suicide, but is afraid to

die. Hypochondriac. Tendency to faint; from odours; in morning; after eating; after every

labour pain. Cannot keep from falling asleep in the evening while sitting or reading hours

before bedtime, and awakes at 3 or 4 A.M. ; falls into a dreamy sleep at daybreak from

which she is hard to arouse, and then feels tired and weak.32 Chilly patient. Worse,

morning, mental exertion, after eating, touch, spices, stimulants, narcotics, dry weather,

52

cold. Better, from a nap, if allowed to finish it; in evening, while at rest, in damp, wet

weather, strong pressure.33

Oophorinum (Ovininum): Ovarian cysts. Cutaneous disorders and acne. Suffering

following excision of the ovaries. Climacteric disturbances generally. Prurigo.33 It has

been suggested as a remedy in ovarian cysts.34

Palladium metallicum: It is indicated in that gynaecological condition where the disease

had its inception in the right ovary, the uterine prolapse and retroversion, the sub acute

pelvic peritonitis and concomitant symptoms being secondary. Pain and swelling in

region of right ovary. Shooting or burning pain in pelvis and bearing-down; relieved by

rubbing. Soreness and shooting pain from navel of breast. Glairy leucorrhoea. Menstrual

discharge while nursing.33 The most important characteristic of Palladium is a feeling of

wounded pride. She is inclined to weep. Everything puts her out of humour; she feels that

everything that has been said or done has been done on purpose to exasperate her by

wounding her dignity.37 She always has an aggravation of her symptoms the day

following an evening's entertainment. She imagines herself very much neglected, and as

she attaches great importance to the good opinion of others, this annoys her very much.38

Phosphorus: Menses too early and scanty-not profuse, but last too long. Amenorrhoea,

with vicarious menstruation. Slight haemorrhage from uterus between periods. Weeps

before menses. Leucorrhoea profuse, smarting, corrosive, instead of menses.33

Nymphomania. Aversion to coitus. Before menses: abundant bleeding of ulcers;

leucorrhoea; want to urinate; and weeping. Frequent and profuse metrorrhagia. On

appearance of menses; incisive, griping pains in the back and vomiting. After menses :

weakness, blue circles round eyes, and anxiety.34 Menses absent with tightness of chest,

dry cough and spitting of blood. Phthisical with delicate, refined skin, sharp and

53

handsome features, long silky eye lashes.41 It is generally adaptable to tall, slender

persons of sanguine temperament and to young people who grow too rapidly, and are

inclined to stoop and show a great tendency to phthisical ailments. Mentally they are

excitable and impressionable and in consequence they easily get into temper. Great

lowness of spirits. Easily vexed. Fearfulness, as if something were creeping out of every

corner. Clairvoyant state. Anxiety, fear and dread are constantly present.37, 41 Chilly

patient. Worse, touch; physical or mental exertion; twilight; warm food or drink; change

of weather, from getting wet in hot weather; evening; lying on left or painful side; during

a thunder-storm; ascending stairs. Better, in dark, lying on right side, cold food; cold;

open air; washing with cold water; sleep.37

Platinum metallicum: Menses too early, too profuse, dark-clotted, with spasms and

painful bearing-down, chilliness, and sensitiveness of parts. Parts hypersensitive.

Tingling internally and externally. Ovaries sensitive and burn. Vaginismus.

Nymphomania. Pruritus vulvae. Ovaritis with sterility. Abnormal sexual appetite and

melancholia.33 Severe stitches in right ovarian region.34 The patient is like some sort of

volatile, highly combustible oil that ignites on the least spark. She is proud, haughty and

faultfinding. She looks very large in her own imagination while others seem insignificant

and small. It is this egotism that makes her so undesirable a companion. Arrogance is

marked in every feature of her countenance. She walks straight like a queen, her head

erect and her eyes turned away from all contemptible creatures around her. Great

changeability of mood.37 Adapted to women, dark hair, and rigid fibre; thin, of a sanguine

temperament; who suffer from too early and too profuse menses. The pains increase

gradually and as gradually decrease and are attended with numbness of parts. Mental

disturbances after fright, grief, vexation; onanism, pride. Mental symptoms appear as

54

physical symptoms disappear and vice versa.32 Generally worse, sitting and standing;

evening. Better, walking.33

Plumbum metallicum: Ovarian diseases affecting mainly the right side. Retarded

menstruation. Amenorrhoea, chloro-anaemia. Nymphomania. Wants to stretch limbs

during ovarian pains. Spasmodic dysmenorrhoea. Cessation of menses on invasion of

colic; may reappear after paroxysm, or not again until next period. Metrorrhagia with

sensation of strong pulling from abdomen to back; during climacteric, dark clots

alternating with fluid blood or bloody serum.34 Lassitude; faints on going into a room full

of company. Slow of perception; intellectual torpor, gradually increasing apathy.

Weakness or loss of memory; unable to find the proper word. Delirium alternating with

colic. Assumes strangest attitudes and positions in bed. Complexion : pale, ash-coloured,

yellow, corpse-like, cheeks sunken; expressive of great anxiety and suffering. Skin of

face, greasy, shiny. Excessive pain in abdomen, radiating to all parts of body.32 Generally

worse, at night, motion. Better, rubbing, hard pressure, physical exertion.33

Podophyllum peltatum: Pain in uterus and right ovary, with shifting noises along

ascending colon. Suppressed menses, with pelvic tenesmus. Prolapsed uteri, especially

after parturition.33 Pain in ovaries, esp. right; extending down limbs. Pain from right

ovary down, anterior crural nerve, pain agg. as it descends; agg. straightening limb.

Shooting pain in right ovary, before and during menses. Ovarian tumour : with pains

extending up to shoulder. Menorrhagia from straining. Menses, retarded; with ovarian,

hypogastric, and sacral pains, agg. from motion, >> lying down. Bearing down in

abdomen and back during menses; ovarian pains running into thighs.34 A peculiar

symptom is amelioration of pain from lying on stomach.37 Adapted to persons of bilious

temperament who suffer from gastro-intestinal derangement, especially after abuse of

55

mercury, "bilious attacks." Thirst for large quantities of cold water. Pains: sudden shocks

of jerking pains. Depression of spirits, imagines he is going to die or be very ill; disgust

for life.32

Pulsatilla nigricans: Amenia due to wet feet; vicarious menses, epistaxis; uterine colic;

morning sickness; bad taste in mouth in the morning.41 Amenorrhoea. Suppressed menses

from wet feet, nervous debility, or chlorosis. Tardy menses. Too late, scanty, thick, dark,

clotted, changeable, intermittent. Chilliness, nausea, downward pressure, painful, flow

intermits.33 Delay of first menses in mild, gentle girls, low-spirited, and diarrhoea during

menses. Leucorrhoea, thick, like cream, or corrosive and burning, principally at period of

catamenia (before, during or after), and sometimes with cuttings.34 Adapted to persons of

indecisive, slow, phlegmatic temperament, with sandy hair, blue eyes, pale face, easily

moved to laughter or tears; affectionate, mild, gentle, timid, yielding disposition- the

woman's remedy.32 She is so gentle that she can hardly say a cruel word to anybody.

People very often take advantage of her sweet disposition. A Pulsatilla wife never

quarrels with her husband. She is very different from those hasty, irritable housewives

that return tenfold of what they get. She is a little indecisive in her character.

Changeability. Weeps easily.37 Morbid dread of opposite sex. Religious melancholy.

Timid, irresolute. Fears in evening to be alone, dark, ghost. Averse to fat food, warm

food, and drink. Thirstlessness, with nearly all complaints. Hot patient. Generally Worse,

from heat, rich fat food, after eating, towards evening, warm room, lying on left or on

painless side. when allowing feet to hang down. Better, open air, motion, cold

applications, cold food and drinks, though not thirsty.33

Rhododendron: Suppressed catamenia. Premature and too profuse catamenia. Fever

with headache at each menstrual period. Pain in ovaries; agg. in change of weather.

56

Caused rupture of cyst in right ovary. Serous cysts in vagina.34 The most characteristic

indication for Rhododendron consists in its aggravation before thunderstorm. It is not so

much due to the damp as to the electrical changes in the atmosphere. Another modality of

Rhododendron consists in its aggravation during rest and amelioration from motion.

Another characteristic symptom is great loss of memory. He omits words while writing,

sudden vanishing of thoughts. This is manifested by sudden stoppage while in the act of

talking; he often desists while in conversation, to enable himself to recall the trend of his

thoughts.37 All symptoms reappear in rough weather, night, towards morning. Better,

after the storm breaks, warmth, and eating.33

Senecio aureus: Menses retarded, suppressed. Functional amenorrhoea of young girls

with backache. Before menses, inflammatory conditions of throat, chest, and bladder.

After menstruation commences, these improve. Anaemic dysmenorrhoea with urinary

disturbances. Premature and too profuse menses.33Aching in both ovarian regions, knees,

and ankles, and down front of thighs. Profuse flow of mucus from vagina. Menses two

days early, very scanty, less pain than usual, followed by excessive thirst and thin

leucorrhoea streaked with blood, and with dull pelvic pains. Menses every three weeks,

very profuse, lasting eight or nine days, accompanied by severe cutting pains in region of

sacrum, hypogastrium, and groins; she was pale, weak, and nervous, and had a slight

cough, generally at night; after an abortion. Suppression of menses from a cold; after

venesection. Menstrual irregularities in consumptive patients. Leucorrhoea : preceded by

headache, sleeplessness and irritable bladder; in little girls; preceded by headache and

sleeplessness.34

Sepia officinalis: Menses Too late and scanty, irregular; early and profuse; sharp

clutching pains. Violent stitches upward in the vagina, from uterus to umbilicus. Prolapse

57

of uterus and vagina. Vagina painful, especially on coition. Bearing-down sensation as if

everything would escape through vulva; must cross limbs to prevent protrusion, or press

against vulva.33 Irregular menses of nearly every form - early, late, scanty, profuse,

amenorrhoea or menorrhagia.32Colic before menses. During menses: irritability,

melancholy, toothache, headache, nose-bleed, and painful weariness in limbs, or

spasmodic colic and pressure towards the parts. Leucorrhoea, or a yellow or greenish red

water, or purulent and fetid, sometimes with inflation of abdomen, or shootings in vagina.

Leucorrhoea in place of menses.34 Sepia is suited to tall, slim women with narrow pelvis

and lax fibres and muscles; such a woman is not well is not well built as a woman. The

love does not go forth into affection, there is a lack of realization, a lack of ability to

register such affections; the love does not manifest itself. It is a striking feature of this

remedy that the affections are stilled; all things seem strange; she does not realize; she

may even be estranged and turned aside from those she loves.35 Adapted to persons of

dark hair, rigid fibre, but mild and easy disposition. Diseases of women: especially those

occurring during pregnancy; childbed and lactation; or diseases attended with sudden

prostration and sinking faintness; "the washer- woman's remedy," complaints that are

brought on by or aggravated after laundry work. "Chills so easily"; lack of vital heat,

Great sadness and weeping. Dread of being alone, of men; of meeting friends; with

uterine troubles. Greedy, miserly. Indolent : does not want to do anything, either work or

play; even an exertion to think.32 Averse to occupation, to family. Irritable; easily

offended. Chilly patient. Longing for vinegar, acids, and pickles. Generally worse,

forenoons and evenings; washing, laundry-work, dampness, left side, after sweat; cold

air, before thunder-storm. Better, by exercise, pressure, warmth of bed, hot applications,

drawing limbs up, cold bathing, after sleep.33

58

Silicea terra: Menses too early and too feeble, or else too profuse. Increased menses,

with paroxysms of icy coldness over whole body. Suppression of the menses. Discharge

of blood before proper period; menses too late; protracted; blood acrid. Metrorrhagia.

Diarrhoea, before the menses. Itching, burning, and soreness in pudenda; during menses.

Leucorrhoea, which flows when urinating, or after the menses. Leucorrhoea, like milk,

flowing at intervals, and preceded by gripping in umbilical region. Acrid, corrosive

leucorrhoea.34 Adapted to the nervous, irritable, sanguine temperament; persons of a

psoric diathesis. Persons of light complexion; fine dry skin; pale face; weakly, with lax

muscles. Constitutions which suffer from deficient nutrition, not because food is lacking

in quality or quantity, but from imperfect assimilation; over-sensitive, physically and

mentally.32 The Silica patient is chilly; his symptoms are developed in cold, damp

weather, though often better in cold, dry weather; symptoms come out after a bath. The

patient lacks stamina. So it is with the mind; when the mind needs Silica it is in a state of

weakness, embarrassment, dread, a state of yielding. Irritable and irascible when aroused;

when let alone he is timid, retiring, wants to shirk everything; mild, gentle, tearful

women.35 Nervous and excitable. Sensitive to all impressions. Brain-fag. Obstinate,

headstrong. Generally feels worse, new moon, in morning, from washing, during menses,

uncovering, lying down, damp, lying on, left side, cold. Better, warmth, wrapping up

head, summer; in wet or humid weather.33

Staphysagria: Ovarian affections from masturbation and from disappointed love.36 Very

sharp shooting pains in ovary, which is exceedingly sensitive to pressure; pains extending

into crural region and thighs. Menses which had ceased for a year reappeared with cutting

colic and violent rumbling, at the new moon. Menses irregular, late, and profuse;

sometimes wanting; first of pale blood, then dark and clotted; occasionally spasmodic

59

uterine contractions. Amenorrhoea from chagrin with indignation. Inflammation of the

ovaries with burning, stinging, and pressing-drawing. Very sharp shooting pains in ovary,

which is exceedingly sensitive to pressure; pains extending into crural region and thighs.

Nymphomania, with extreme sensitiveness to mental and physical impressions; mind

dwells too much on sexual subjects. Painful sensitiveness of genital organs.34 Excitable,

easily aroused to anger, but seldom irascible, that is, easily disturbed and excited, but

seldom manifests it. Suitable in cases where complaints come from pent up wrath,

suppressed anger, suppressed feelings. The person becomes speechless from suppressed

indignation; anger with indignation. Great indignation about things done by others or by

himself; grieves about consequences. Indifferent, low-spirited, dullness of mind after

onanism. Suppressed anger. Staph. cures these conditions when they are the result of

sexual excitement, masturbation, excesses in venery, allowing the mind to dwell too

much on venereal subjects. Thinking on sexual relations. These patients are irritable,

easily fatigued, most excitable, and when they have to control their emotions they suffer

intensely.35 The patient generally worse, anger, indignation, grief, mortification, loss of

fluids, onanism, sexual excesses, tobacco; least touch on affected parts. Better, after

breakfast, warmth, rest at night.33

Sulphur: Menses too late, short, scanty, and difficult; thick, black, acrid, making parts

sore. Menses preceded by headache or suddenly stopped. Leucorrhoea, burning,

excoriating. Much offensive perspiration.33 Delay of first menses. Amenorrhoea, dreadful

depression and apprehension, head feels full and heavy, followed by violent headache,

numbness of arms legs, cramp and sick feeling. Catamenia premature and too profuse; or

too feeble or entirely suppressed particularly in psoric individuals, with colic, abdominal

spasms, headache, pains in loins, pressure at stomach, congestion in head, and nasal

60

haemorrhage, agitation, and even attacks of epilepsy. Before menses : headache, itching

in the parts; spasmodic colic; cough; toothache; pyrosis; epistaxis; leucorrhoea, and

asthmatic sufferings. Bearing down in pelvis; congestion to uterus. Sterility, with too

early and profuse menstruation.34 Burning pains. The Sulphur patient is a lean, lank,

hungry, dyspeptic fellow with stoop shoulders, yet many times it must be given to fat,

rotund, well-fed people. Persons who lead sedentary lives.35 Standing is the worst

position for Sulphur patients; they cannot stand; every standing position is

uncomfortable. Aversion to being washed; always < after a bath. Too lazy to rouse

himself; too unhappy to live. Filthiness and offensive. Happy dreams, wakes up singing.

Everything looks pretty which the patient takes a fancy to; even rags seem beautiful.32

Irritable. Affections vitiated; very selfish, no regard for others. Religious melancholy.

Averse to business; loafs-too lazy to arouse himself. Imagining giving wrong things to

people, causing their death. Generally worse, at rest, when standing, warmth in bed,

washing, bathing, in morning, 11 a.m., night, from alcoholic stimulants, periodically.

Better, dry, warm weather, lying on right side, from drawing up affected limbs.33 Hot

patient.

Syphilinum: Tendency to ovarian tumours. Congestion of ovaries. Sore aching in left

ovarian region, extending to right with darting pains. Ovary swelled so much that its size

and shape could easily be felt through abdominal walls.44 Uterine and ovarian diseases

with pronounced nervous disorders, esp. in married women. Leucorrhoea profuse, thin,

watery, acrid, with sharp, knife-pain in ovaries.33 Acrid discharge causing violent itching

and inflammation of external organs, agg. at night from warmth of bed, parts very tender;

itching and inflammation >> during menses. Menstruation painful, two weeks too soon;

pink-red, bright, profuse, running free for some days; napkins wash easily. Painful

61

menstruation. Sensitiveness of os uteri, agg. to intolerable pain at menses, or on

introduction of finger or penis; frequently causes abortion. Nocturnal agg. of right

ovarian pain, preventing sleep. Ovaries congested and inflamed; tendency to ovarian

tumours. Sore aching in left ovarian region, extending to right with darting pains.34 Pains

from darkness to daylight; begin with twilight and end with daylight. Pains increase and

decrease gradually; shifting and require frequent change of position.32 For Syphilitics, or

patients who have had chancre treated by local means, and as a result have suffered from

throat and skin troubles for years, are nearly always benefited by this remedy at the

commencement of treatment, unless some other remedy is clearly indicated. Craving for

alcohol in any form is the next important characteristic. Fetidity of all the discharges and

secretions. Marked emaciation.37 Loss of memory; remembers everything previous to his

illness. Apathetic; feels as if going insane or being paralyzed. Fears the night, and the

suffering from exhaustion on awakening. Hopeless; despairs of recovery. Worse, at

night, sundown to sunrise, seashore, in summer. Better, inland and mountains, during

day, moving about slowly.33

Thuja occidentalis: Menses scanty, retarded. Profuse leucorrhoea; thick, greenish.

Severe pain in left ovary and left inguinal region. Affections of ovaries especially left

side.34 This remedy is a great antisycotic remedy. Distressing, burning pain in left ovarian

region when walking or riding, must sit or lie down; worse at each menstrual nisus.32

Menses: too early and too short; scanty, with terrible distressing pain in left ovarian and

iliac region. Pain, located in ovaries or duct, from over-physiological action.34 Adapted to

hydrogenoid constitution of Grauvogl, which is related to sycosis as effect is to cause.

Acts well in lymphatic temperament, in very fleshy persons, dark complexion, black hair,

unhealthy skin. Ailments: from bad effects of vaccination; from suppressed or maltreated

62

gonorrhoea. Fixed ideas: as if a strange person was at his side; as if soul and body were

separated; as if a living animal were in abdomen; of being under the influence of a

superior power. Insane women will not be touched or approached.32 Many women suffer

from grumbling pains in the ovaries all the time, they have a sense of the organ, which

they should not feel; pain from taking cold or in change of weather; the increase of the

pain in the left ovary is the first sign; sometimes the pain is so severe that the right one

suffers apparently from sympathy. Where the ovaries have been affected for some time

there will be mental symptoms, a most violent irritability, jealousy, quarrelsomeness,

ugliness. It seems to her that she is very delicate, that she is made of glass and that she

will break. The idea is that she will break, and not that she is transparent.35 The patient

feels generally worse, at night, from heat of bed; at 3 a.m. and 3 p.m.; from cold, damp

air; after breakfast; fat, coffee; vaccination. Better, left side; while drawing up a limb.33

REPERTORIAL APPROACH:

1. Boericke’s repertory: 33

Chapter: Female sexual system

Cysts, Dropsy: Apis, Apoc, Arn, Ars, Aur-i, aur-m-n, Bell, Bov, Bry, Chin, Coloc, Con,

Ferr-i, Graph, Iod, Kali-br, Lach, Lil-t, Lyc, Med, Ov, Rhod, Sab, Tereb, Zinc

2. Clarke’s Clinical Repertory: 45

Ovaries, affections of: Act.r, Am.br, Arg, Bov, Cth, Col, Con, Crt.h, Ham, Hep, Iod, K.br,

Kre, Lc.c, Lach, Lil, Merc, Naj, Na.hch, Pal, Plat, Sbl, Sbi, Sac.l, Stp, Syp.

Ovaries, cyst of – Rho

Ovaries, tumours of – Aps, Gph, Oop, Pod, Rhs, Sec.

63

3. Complete repertory: 46

Chapter: Female

Tumours – generals – cysts – ovaries: Abrot, APIS, Apoc, Arg-met, Arn, Ars,

Aur, AUR-I, AUR-M-N, Bell, BOV, Bry, BUFO, Canth, Carb-an, Carc, Chin, COLOC,

Con, Ferr-i, Foll, Form, Graph, IOD, KALI-BR, Kali-fcy, LACH, Lil-t, LYC, Med,

Merc, Murx, OV, PLAT, Podo, Prun, Rhod, RHUS-T, Sabin, Syc, Syph, Ter, Thuj, Zinc

4. Murphy’s repertory: 47

Chapter: Female

Tumours, ovaries: APIS, Apoc, Ars, Ars-i, Aur-m-n, Bar-m, Bov, Calc, Coloc,

Con, Ferr-i, Fl-ac, Graph, Hep, Iod, Kali-br, Lach, Lyc, Med, Ov, Pall, Plat, Podo, Sec,

Staph, Stram, Syph, Thuj, Zinc.

Cysts, ovarian: : APIS, Apoc, Ars, Aur-i, Aur-m-n, Bell, Bov, Bry, Bufo, Canth,

Carb-an, Chin, Colch, Coloc, Con, Ferr-i, Form, Graph, Iod, Kali-br, Kali-fcy, Lach,

Lil-t, Lyc, Med, Merc, Murx, Ov, Plat, Prun, Rhod, Rhus-t, Sab, Sep, Syc, Syp, Ter,

THUJ, Zinc.

Left: apis, coloc, Kali-bi, LACH, Podo, Sil, THUJ

Right: APIS, Fl-ac, Iod, LYC, Podo, Sil

5. Concise repertory of homoeopathic medicines by Dr. S.R. Phatak: 48

Ovaries, cystic: Ap, Apoc, Arg-m, Aur, Bov, Form, Kali-br, Iod, Lyc

6. Synthesis repertory: 49

Chapter: Female Genitalia/ Sex

Tumors – ovaries- cysts: : Apis, Arg-met, Bov, Bufo, Canth, Carb-an, Coloc, Iod,

Kali-br, Lach, Merc, Murx, Plat, Prun, Rhod, Rhus-t, Syph, Thuj

Methodology

64

MATERIALS AND METHODS

Source of data:

This study on Polycystic Ovarian Syndrome was conducted in patients who

reported to outpatient department of Father Muller Homoeopathic Medical College and

Hospital, Kankanady and Deralakatte, Mangalore.

A total number of 30 cases were screened aged between 15 and 30 yrs for the

study. The diagnosis was made on the basis of strong clinical presentation, examination

finding as well as investigations, when required. The cases were selected for the study

after fulfilling the inclusion as well as exclusion criteria. The case selection was done

randomly.

Inclusion criteria for selection of patients:

Females between the age group of 15 – 30 yrs.

Cases without any other gynaecological problems.

Exclusion criteria:

Females in the age group less than 15 years and more than 30 years.

Cases with other gynaecological complications.

Method of Collection of Data:

Data was collected from patients by interviewing the patients and after clinical

examination.

All the data were recorded in standardized case record of Father Muller

Homoeopathic Medical College.

65

Once the data was recorded, it was processed as per guidelines adapted in the

standardized case record of Father Muller Homoeopathic Medical College.

A totality of symptoms was erected in each case, taking in consideration of

personality assessment as per the principles of Homoeopathy.

A remedy was selected for each case after referring to Homoeopathic Materia

Medica and various Repertories.

Therapeutic plan was evolved individually for each case as per the SCR guidelines.

The cases were followed up to a minimum period of 3-6 months.

After following up cases the inferences were drawn by analysis of the outcome.

A profile of remedies was erected after consulting the source books of Homoeopathic

Materia Medica and Homoeopathic Repertories.

The method used in the study was a clinical method for confirmation and the

results obtained has been scientifically analyzed and evaluated. There were no control

groups used in the study and all the patients were treated on out – patient basis.

Investigations were done in few cases only as in some cases the clinical history and the

examination findings were sufficient to arrive at a diagnosis and were fulfilling the

criteria and also all patients were not affordable for the investigations.

The remedy selection in individual cases was based on the analysis of

symptomatology – such as etiological factors, qualified mental generals, physical

generals, concomitants, characteristic particulars, repertorial references and other Materia

Medica sources. Various potencies have been used in this study. Repetition and potency

regulation, mostly in ascending potencies was based on Homoeopathic posology. No

concomitant therapy such as Allopathic treatment or any other was used. Subjects, who

66

were already on other therapy, were asked to discontinue the same. Placebo

administration was done in some cases.

Follow-ups:

Same potencies were repeated in some cases, and in some cases potencies were

raised to the next higher potencies. In some cases remedies that follow well and inter

current were also given as per the need and indication. Each case was followed up to a

minimum period of three to six months from the commencement of treatment. Majority

of the cases was reviewed on once in two weeks initially and once in a month on

considerable improvement. Follow up criteria were adapted for assessing the changes

observed.

Diet and Regimen:

In majority of cases, the patients were directed to continue the same diet as

earlier. No specific supplementary diet was prescribed. But patients who had increase in

weight were told to avoid high calorie diet.

Ancillary Measures: Patients were advised to do mild exercise to avoid the increase in

weight and some who were having mental stress were told to do meditation.

Assessment of effectiveness:

After following up the cases, assessment of the effectiveness of treatment was

done based on the following criteria:

a) Clinical Assessment:

General improvement.

Regularity of menses.

Reduction in weight

67

Reduction in other symptoms like acne, hirsutism, abdominal or back pain.

b) For an effective evaluation and assessment, disease intensity was graded in every

patient based on their presentation observed during case taking. After completion of the

study, the post treatment disease scores were compared with the pre-treatment disease

intensity scores and statistically evaluated.

Homoeopathic remedies used in this study:

In Homoeopathy treatment, the remedies were prescribed in three different levels

according to the Principles of Homoeopathy:

a) Acute or sector remedies were used whenever there was a necessity of specific remedy.

b) Deep acting constitutional remedies were given in all cases based on the constitutional

totality.

c) Anti-miasmatic (intercurrent) remedies were prescribed in some cases when they did

not respond or when there were no characteristic symptoms available.

Results

68

RESULTS

This section contains the description of data collected from 30 cases, who

attended the OPD of Father Muller Homoeopathic Medical College and Hospital at

Kankanady and at Deralakatte. The cases were selected on the basis of purposive

sampling method. The data collected from these patients were subjected to statistical

analysis. Descriptive, inferential statistics are used in analysis and interpretation of study.

The observations made and results of this analysis are presented in the form of tables,

diagrams and charts.

The data obtained in grouped into two different sections:

SECTION – A: DEMOGRAPHY

SECTION – B: TO TEST THE EFFECTIVENESS OF THE TREATMENT

69

DEMOGRAPHY

A total number of thirty cases were included in the study after screening the case

as per the inclusion criteria. All the thirty cases were followed up for a minimum period

of three to six months. These cases were subjected to statistical study. The statistical

analysis is given below:

Case distribution:

Table 1: Distribution of cases according to age:

Age in years Number of cases Percentage (%)

15 – 20 11 36.67

20 – 25 13 43.33

25 – 30 6 20

Total 30 100

Figure 11: Distribution of cases according to age group

11 13

6

36.67

43.33

20

05

101520253035404550

15 - 20 20 - 25 25 - 30

No. of cases Percentage

70

Out of 30 cases included in the clinical study of Polycystic Ovarian syndrome, the

maximum prevalence was noticed in age group 20 – 25 yrs, 13 (43.33%) patients were

from this group, the next important age group according to the prevalence was the age

group 15 – 20 yrs consisting 11 (36.67) patients and 6 (20%) patients were belonging to

the age group 25 – 30.

Table 2: Distribution of cases according to religion:

Religion Number of cases Percentage

Hindu 16 53.33

Christian 6 20

Muslim 8 26.67

Total 30 100

Figure 12: Distribution of cases according to religion

0

10

20

30

40

50

60

HinduChristian

Muslim

16

6 8

53.33%

20%26.67% No of cases

Percentage

71

Out of 30 cases included in the clinical study of Polycystic Ovarian syndrome, 16

cases (53.33%) belonged to Hindu religion, 6 cases (20%) belonged to Christian religion

and 8 cases (26.67%) belonged to Muslim religion.

Table 3: Distribution of cases according to occupation:

Occupation No. of cases (%)

Student 16 53.33

Teaching profession 2 6.67

House wife 6 20

Officials 1 3.33

Beedi rolling 4 13.33

Tailor 1 3.33

Total 30 100

Figure 13: Distribution of cases according to occupation

53.33

6.67

20

3.3313.33

3.33

Percentage

StudentTeaching professionHouse wifeOfficialsBeedi rollingTailor

72

Out of 30 cases, 16 (53.33%) patients were students, 4 (13.33%) cases were beedi

rollers, 6 (20%) patients were house wife, 2 (6.67%) were teachers and 1 (3.33%) each

were tailor and official.

Table 4: Distribution of cases according to the clinical presentation:

Clinical presentation No. of cases Percentage

Irregular menses

Once in 20 days

Once in 40 – 45 days

Once in 2 months

Once in 3 months

Once in 4 months

1

11

9

4

2

3.33

36.67

30

13.33

6.67

Amenorrhoea 3 10

Weight gain 6 20

Hirsutism 9 30

Acne 8 26.67

Scanty menstrual flow 6 20

Profuse menstrual flow 11 36.67

Infertility 2 6.67

The clinical presentation varied in different cases. Regarding irregularity of

menses, irregular menses once in 20 days was present in 1 case (3.33%), irregular menses

once in 40 – 45 days was present in 11 cases (36.67%), irregular menses once in 2

73

months was present in 9 cases (30), irregular menses once in 3 months was present in 4

cases (13.33%), irregular menses once in 4 months was present in 2 cases (6.67%) and

amenorrhoea was present in 3 cases (10%), weight gain was present in 6 cases (20%),

hirsutism was present in 9 cases (30%), acne in 8 cases (26.67%), scanty menstrual flow

was noticed in 6 cases (20%), profuse flow in 11 cases (36.67%) and infertility in 2 cases

(6.67%).

Figure 14: Distribution of cases according to the clinical presentation

0

5

10

15

20

25

30

35

40

1

119

42 3

6

9 86

11

23.33

36.67

30

13.33

6.67

10

20

30

26.67

20

36.67

6.67No. of casesPercentage

74

Table 5: Distribution of cases according to miasm:

Figure 15: Distribution of cases according to miasms

Out of 30 cases, psoric expression was well marked in 1 case (3.33%), sycotic

miasm in 16 cases (53.34%) and psoro – sycotic was marked in 13 cases (43.33%).

3.33

43.3353.34

Percentage

Psora Psoro SycosisSycosis

Miasm No. of cases Percentage

Psora 1 3.33

Psoro – Sycosis 13 43.33

Sycosis 16 53.34

Total 30 100

75

Table 6: Distribution of Constitutional Medicines used in this study:

Remedy No. of cases %

Natrum mur 10 33.33

Pulsatilla 7 23.33

Lycopodium 4 13.33

Phosphorus 2 6.66

Sepia 2 6.66

Graphities 1 3.33

Ignatia 1 3.33

Lachesis 1 3.33

Silicea 1 3.33

Calcarea carb 1 3.33

Total 30 100

Out of 30 cases, Natrum mur was prescribed as a constitutional remedy in 10

cases (33.33%), Pulsatilla was prescribed as constitutional remedy in 7 cases (23.33%),

Lycopodium was prescribed as a constitutional remedy in 4 cases (13.33%), Phosphorus

and Sepia were prescribed as constitutional remedy in 2 cases each (6.66%), Graphities,

Ignatia, Silicea, Calcarea carb and lachesis were prescribed as constitutional remedies in

1 case each (3.33%).

76

Figure 16: Distribution of cases according to remedies prescribed

Table 7: Distribution of cases according to the potency of Homoeopathic Medicines

used in this study. (Constitutional Medicine):

Potency Before/ After 30 % 200 % 1M % 10M % 0/1 %

30

200

1M

10M

0/1

2

-

-

-

-

6.67

-

-

-

-

-

9

-

-

-

-

30

-

-

-

1

8

6

-

-

3.33

26.67

20

-

-

-

1

1

-

-

-

3.33

3.33

-

-

1

1

-

-

-

3.33

3.33

-

-

-

Total 2 9 15 2 2

107

42 2 1 1 1 1 1

33.33

23.33

13.33

6.66 6.663.33 3.33 3.33 3.33 3.33

0

5

10

15

20

25

30

35

No. of cases Percentage

77

Figure 17: Distribution of cases according to the potency

Out of 30 cases included in this clinical study, in all the cases deep acting

constitutional medicine has been prescribed and the potency analysis of constitutional

medicine has been evaluated for the statistical analysis among 30 cases. In 2 cases

(6.67%) the remedy was started with 30th potency, in 1 case (3.33%) it was raised from

30 to 1M potency and in 1 case (3.33%) it was raised to 0/1 potency. In 9 cases (30%) it

was started with 200 potency, raised to 1M potency in 8 cases (26.67%), raised to 10M in

1 case (3.33%) and raised to 0/1 potency in 1 case (3.33%). In 6 cases (20%) it was

started with 1M potency and raised to 10M potency in 1 case (3.33%). None of the cases

were started with 10M and 0/1 potency. To conclude, 200th potency was used in

maximum number of cases 9 cases (30%) during the beginning of the treatment but by

the end of the treatment, 1M potency was used in maximum number of cases i.e. 15 cases

(50%).

0 5 10 15 20

30

200

1M

10M

0/1

2

9

1

8

6

1

1

1

1

302001M

10M

0/1

78

Table 8: Distribution of cases according to the treatment outcome:

Treatment outcome No. of cases Percent

Improved 25 83.33

Not improved 3 10

Drop out 2 6.67

Total 30 100

Out of 30 cases, 25 cases (83.33%) showed good improvement, 3 cases (10%)

were not improved and 2 cases (6.66%) were drop out.

Figure 18: Distribution of cases according to treatment outcome

83.33%

10%

6.66%

25

3

2

0 20 40 60 80 100

Improved

Not improved

Drop out

No.of cases

Percentage

79

Figure 19: Statistical Analysis

9 9

7

5

12

7

11

7

12

6

13

8

10

6

5

12

7

9

10

8

11

10

9 9 9

10

8

10 11

4

2

1

5

1

2

1

2

1

2

6

4

2 2 2

1

3

2

1

7

1

2

8

3

2

1 1

3 3

11

4

0

2

4

6

8

10

12

14

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

ScoreBefore Score after

80

Table 9: Distribution of the scores before and after the treatment

Case No X Y X – Y= Z (Z – Ż) (Z – Ż)2

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

9 9 7 5

12 7

11 7

12 6

13 8

10 6 5

12 7 9

10 8

11 10 9 9 9

10 8

10 11 4

2 1 5 1 2 1 2 1 2 6 4 2 2 2 1 3 2 1 7 1 2 8 3 2 1 1 3 3 11 4

7 8 2 4 10 6 9 6 10 0 9 6 8 4 4 9 5 8 3 7 9 2 6 7 8 9 5 7 0 0

1.07 2.07 -3.93 -1.93 4.07 0.07 3.07 0.07 4.07 -5.93 3.07 0.07 2.07 -1.93 -1.93 3.07 -0.93 2.07 -2.93 1.07 3.07 -3.93 0.07 1.07 2.07 3.07 -0.93 1.07 -5.93 -5.93

1.14 4.28 15.44 3.72 16.56

0.0049 9.42

0.0049 16.56 35.16 9.42

0.0049 4.28 3.72 3.72 9.42 0.86 4.28 8.58 1.14 9.42 15.44

0.0049 1.14 4.28 9.42 0.86 1.14 35.16 35.16

Total 264 86 178 259.74

X = score before the treatment; Y = score after the treatment

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A. Question to be answered: Is there any difference between the scores taken before

the treatment and scores after the homoeopathic treatment?

B. Null hypothesis: There is no difference between the scores before and after the

Homoeopathic treatment?

C. Standard error of the mean of difference

n = 30

X = Score before treatment

Y = Score after treatment

Z = Mean difference

Z = 178

Ż = Z/n

= 178/30

= 5.93

(Z - Z)2 = 259.74

The estimate of population standard deviation is given by

SD = √ (Z - Ż)2 / n-1

82

= √259.74/30-1

= √259.74/29

= √ 8.96

= 2.99

The estimate of standard error of mean = SD / √n

= 2.99/√30

= 2.99/5.47

= 0.55

D. Critical Ratio:

‘t’ = Ż/ SD / √n

= 5.93/0.55

= 10.78

83

E. Comparison with tabled value:

This critical ratio, t follows a distribution with n-1 (29) degrees to freedom. The

5% level is 2.045 and 1% level is 2.756 for 29 degrees of freedom. Since the calculated

value 10.78 is greater than tabled value at 5% and 1% level, we reject the null hypothesis.

Inference:

This study provides evidence to say that, there is significant reduction in the

disease intensity scores after the Homeopathic treatment. Therefore the Homeopathic

medicines are highly effective in the treatment of polycystic ovarian syndrome.

84

REMEDY PROFILE

Out of 30 cases included in this clinical study of Polycystic Ovarian Syndrome

there are some constitutional medicines which had come in two or more than 2 cases and

those cases are studied in detail and the general characters of those cases belonging to the

same remedies been evolved by screening them. By this method a drug image is been

obtained that is nothing the remedy profile.

Out of 30 cases:

NATRUM MUR:

The remedy Natrum mur is prepared from the common salt, a medicine which

belongs to the mineral kingdom. It is a chemical compound of sodium and Chlorine. It is

found in nature in the form of rocks of salt in North West border or Pakistan, dissolved in

Natrum mur was prescribed as a constitutional remedy in 10 cases and as follow well in 1 case.

Pulsatilla was prescribed as constitutional remedy in 6 cases and as follow well in 3 cases.

Lycopodium was prescribed as a constitutional remedy in 4 cases.

Phosphorus was prescribed as constitutional remedy in 2 cases.

Sepia was prescribed as constitutional remedy in 2 cases.

Graphities was prescribed as constitutional remedy in 1 case.

Ignatia, Calcarea carb, Silicea and Lachesis were prescribed as constitutional remedies in 1 case each.

Thuja was given as intercurrent in 7 cases

Sulphur was given as intercurrent in 5 cases.

Medorrhinum was used as intercurrent in 2 cases.

85

sea water and lakes, in atmosphere and cells and fluids of plants and animals. The pure

salt in used. Natrum mur was prescribed as constitutional remedy in 10 cases (1, 2, 6, 8,

9, 12, 17, 19, 20, 25) and in one case Natrum mur was prescribed as follow well of

Ignatia (Case 29).

Cases 1 2 6 8 9 Emotional state

Anger when scolded unnecessarily Weeping when alone. Sensitive Anger when day’s work is not completed Fastidious. Likes to be alone Consolation <

Consolation <2. Gets angry fast2. Weeps easily; fastidious Wants to be left alone when gets sad

Reserved Consolation < Irritable Contradiction agg

Reserved2

Desires to be alone Contradiction agg

Irritable2

Anger-shouts back Consolation <

Complaints started after disappointed love and disappointment in career. Reserved2 Fastidious2

Appearance Stocky Stocky Stocky Lean Stocky Perspiration Increased

generally Decreased generally

Increased in neck and popliteal fossa

More on palms and face

Nothing significant

Desires and aversions

Cr: Chocolates2, ice cream2, Salty food2

Av: Sweets

Cr: chicken, warm food, eggs3, sweets2, fish2.

Cr: fried food2

Cr: salt2, milk

Nothing significant

Bowel habits

Regular Hard Regular Regular Regular

Miasm Sycosis Psora PsoroSycotic Psoro-Sycotic Psoro- Sycotic

Thermal Hot Chilly Hot Hot Hot Physical complaints

Irregular menses once in 40 – 45 days since 1 yr Profuse flow. Clots – slight. Increase in weight more than 6 kgs. Moderate dysmenorrhoea

Irregular menses once in 3 months with profuse flow and black clots. since 1 yr

Irregular menses once in 4 months since 1 yr Profuse flow. No clots and pain Mild hair growth is there on the upper lip

Acne - pustular and painful on face and forehead since 1 yr < after menses Irregular menses once in 40 – 45 days. Scanty flow.

Irregular menses once in 45 – 50 days since 2 yrs Flow normal. Clots – mild Mild pimples (acne) on face

86

Cases 12 17 19 20 25

Emotional

state

Desires to be alone3 Consolation agg Reserved

Weeps easily for silly things Gets angry soon and shouts back Irritable2. Wants to be alone2. Remorse3

Dependant. Suppressed emotions2

Brooding 2 Weeps when alone. Wants to be alone

Irritable3. Gets angry soon Wants to be alone Consolation amelioration Indecisive

Appearance Stocky Lean Stocky Lean Lean

Perspiration Increased on face

Decreased generally

Increased on upper lip

Scanty Scanty

Desires and

aversions

Nothing significant

Cr: spicy2, sweets

Cr: fish3

Cr: spicy3

Av: sweets2

Cr: sweets3

Bowel habits Regular Regular Habitual constipation

Regular Regular

Miasm Sycosis Sycosis Psoro- Sycotic

Sycosis Sycosis

Thermal Hot Hot Hot Hot Hot

Physical

complaints

Irregular menses once in 2 months since 9 yrs (since menarchy) Scanty flow with abdominal pain, back pain and clots

Irregular menses once in 2 months since 1 yr. Infertility (married since 3½ yrs)

Irregular menses once in 3 months since 2 yrs. Spotting, clots present Increased hair growth on upper lip Mild abdominal pain during menses

Irregular menses once in 3 months since 2 yrs Scanty flow with clots and moderate abdominal pain during the menses

Irregular menses once in 20 days since 3 yrs with back pain and clots.

Mentals:

Emotionally Natrum mur is irritable and gets angry fast which is noticed in 6 cases

in this study (no: 1, 2, 6, 8, 17 and 25), though irritability is the prominent symptom of

Natrum mur yet it was not noticed in certain cases (no: 9, 12, 19 and 20), where still the

87

medicine proved to be effective. Another guiding symptom of this remedy is the person

gets worse from consolation which is noticed in 5 cases (no: 1, 2, 6, 8 and 12) but the

remaining cases did not cover this symptom (no: 9, 17, 19, 20) and 1 case (no: 25) had

the symptom of consolation amelioration which is not the usual symptom we find in the

text. But in this study it was noticed that this symptom also was a mental feature in a

patient who received Natrum mur. Next guiding symptom of Natrum mur is wants to be

alone to cry and prefers to be alone otherwise also which is noticed in 7 cases (no: 1, 2, 8,

12, 17, 20 and 25) and the remaining 3 cases (no: 6, 9 and19) did not have that mental

feature. Natrum mur personalities are usually reserved, but this feature is noticed only in

4 cases in this study (no: 6, 8, 9 and 12). This suggests that Natrum mur can be thought of

in persons who are not reserved also. Natrum mur persons are fastidious also, but this

feature is covered by 3 cases (no: 1, 2 and 9). So this medicine can be indicated in

persons who are not reserved. The very prominent symptom of Natrum mur which is

ailments from disappointment was noticed in only one case based on which the medicine

was selected (no: 9). Other symptoms like brooding (no: 20) and suppressed emotions

(no: 19) which are otherwise the red line symptom of Natrum mur were also noticed in

only one case each.

Physicals:

Usually Natrum mur patients are lean, thin and emaciated according to the text.

But here in this study it is found that Nat m was indicated and effective in 6 patients who

were stocky (no: 1, 2 , 6, 9, 12 and 19) and the other 4 cases were lean (no: 8, 17, 20 and

25). Regarding the perspiration, Nat m people have increased perspiration which is

noticed here in 5 cases (no: 1, 6, 8, 12 and 19) and it was scanty or decreased in 4 cases

88

(no: 2, 17, 20 and 25) and also each patient showed difference in the presentation like

perspiration in different parts which is not otherwise very frequently found in the texts.

Perspiration increased in palms and face in 1 case (no: 8), on upper lip in 1 case (no: 19)

and in neck and popliteal fossa in 1 case (no: 6). Regarding the desires and aversions of

Nat m mostly we will encounter the features like desire for salt and fish and aversion to

bread and fat food, craving for salts was noticed in 2 cases (no: 1 and 8), craving for fish

in 2 cases (no: 2 and 19). But in these cases certain other desires and aversions are also

noticed like craving for sweets was noticed in three cases (no: 2, 17 and 25), craving for

spicy in 2 cases (no: 17 and 20), aversion to sweets was noticed in 2 cases (no: 6 and 8)

and very rare symptoms like craving for ice cream and chocolates was also seen (no: 1).

Usually Nat m patients are thermally hot. And in this study it was noticed 9 patients were

hot (case no: 1, 6, 8, 9, 12, 17, 19, 20 and 25) and one was chilly (case no: 2) where in

also Nat m proved to be effective. Usually Nat m has constipation or hard stools. But here

all the cases have regular stool except 2 cases where there is hard stool in one case (no: 2)

and habitual constipation in one case (no: 19).

Miasm:

Nat m has the psoric miasm as the fundamental miasm and sycosis as the

dominant miasm. Here 5 cases have sycosis as the dominant miasm (no: 1, 12, 17, 20 and

25), one case has psora as the dominant miasm (no: 2) and 4 cases have the psoro sycotic

background (no: 6, 8, 9 and 19).

Presenting complaints:

According to the materia medica text the menstrual complaints of Nat m are

irregular menses which is profuse. The irregularity of menses is also noticed in all the

89

cases here but with difference in the duration of the irregularity. Irregularity once in 4

months was noticed in one case (no: 6), irregular menses once in 3 months in 3 cases

(no: 2, 19 and 20), irregular menses once in 2 months in 2 cases (no: 12 and 17), irregular

menses once in 45 – 50 days in one case (no: 9), irregular menses once in 40 – 45 days in

2 cases (no: 1 and 8) and irregular menses once in 20 days in one case (no: 25). Nat m has

a tendency to develop acne with oily face. In this study acne was noticed as one of the

presenting complaints in 2 cases (no: 8 and 9). Hirsutism was noticed in 2 cases (no: 6

and 19).

PULSATILLA:

The remedy pulsatilla is made from the meadow anemone, pulsatilla nigricans, a

plant of the Ranunculaceae family which grows in the plains and pasture land of central

and Northern Europe is commonly known as wind flower. It is small and delicate, with a

flexible stem, which bends one way or another according to the direction of the prevailing

wind. The oil of Pulsatilla when applied to skin has a very irritant action producing

tingling sensation with vesicle formation.

It is pre eminently a female drug which is indicated in mild, gentle and yielding

disposition and in persons who are slow and indecisive. It is a deep acting, polychrest

remedy which is mostly prescribed as a constitutional medicine. In this case study of

Polycystic ovarian syndrome out of 30 cases, Pulsatilla was prescribed as constitutional

in 7 cases (case no: 3, 14, 16, 18, 21, 22 and 24) and as follow remedy in 3 cases (case

no: 25, 28 and 30).

90

Cases 3 14 16 18

Emotional

state

Shyness2

Dull2

Mild and gentle

Company likes

Consolation amel

Changeable2

Slow and

sluggish in all

actions

Mild and

yielding2

Company –

likes2

Consolation –

likes

Weeps easily2. Mild2

& shy

Likes company.

Likes consolation

Timid. Stage fear.

Changeable mood.

Likes to be

alone

Irritable.

Sensitive.

Weeps easily3.

Fear of dark.

Fear of

strangers.

Appearance Stocky Lean Lean Stocky

Perspiration Increased on face Increased

generally

Increased on back,

chest, palms and soles

Nothing

significant

Desires &

aversions

Cr: spicy2 Cr: ice cream

Cr: chicken, ice

cream, spicy food2

Cr: chocolates,

spicy items3.

Av: Bitter

Bowel

habits

Regular Regular Regular Regular

Miasm Sycosis Sycosis Psoro – Sycotic Psoro-

Sycotic

Thermal Hot Hot Hot Hot

Physicals Amenorrhoea

since 8 months

Increase in

weight more than

12 kgs

Mild hair growth

on the upper lip

Flow – moderate

Irregular menses

once in 2

months

Irregular menses once

in 3 months since 2

yrs.

Profuse flow with

clots. Dark bleeding.

Slight lower

abdominal pain

Acne -itching, painful

< during menses

Hair fall, dandruff

Irregular menses

once in 2-3

months since 2

yrs.

Profuse bright

red flow

91

Cases 21 22 24

Emotional

state

Mild

Company likes

Consolation amel2

Weeping while

narrating the

complaints

Fear of thunderstorm

Ambitious

Likes to be in

company3

Fear of opposite sex2

Does not like

contradiction

Likes company. Mild2

Dependant

Indecisive2.

Likes consolation.

Anxiety & fear about

exams.

Appearance Stocky Stocky Lean

Perspiration Nothing significant Increased on chest,

back of neck.

Increased on face especially

upper lip

Desires &

aversions

Cr: Spicy2, sweets

Av: sour

Cr: chicken2, ice

cream3, spicy3, salt3

Cr: sweets

Bowel

habits

Regular Regular Regular

Miasm Sycosis Psoro-sycotic Psoro-

sycotic

Thermal Chilly Hot Hot

Physicals Irregular menses once

in 2 months since

puberty (12 yrs of

age).

Profuse bleeding.

Weight gain – 13 kgs

in 1 yr

Mild facial hair growth

Primary infertility

(married since 10 yrs)

Acne on face, chest

and back with itching.

Pustular eruption

Increased hair growth

on face.

Irregular menses once

in 4-6 months with

clots and scanty flow

since 4 yrs

Irregular menses once in 40

days

Profuse bleeding with clots

92

Mentals:

Emotionally, Pulsatilla is usually mild and yielding disposition. In this study mild

nature was noticed in 5 cases (no: 3, 14, 16, 21 and 24) but not seen in 2 cases (no: 18

and 22). Puls personalities have timidity as one of the feature. But in this study only two

cases showed the feature of shyness (no: 3 and 16) whereas the other cases (no: 14, 18, 22

and 24) did not have this feature. Changeability is a very prominent indication of Puls.

Out of 6 cases, changeability and indecisiveness was seen in 3 cases (no: 14, 16 and 24).

Fear also is a marked symptom of Puls where the patient may have fear of being alone,

dark etc and in this study also was noticed in majority of the cases that is in 5 cases (no:

16, 18, 21, 22 and 24) and also the reasons for fear also varies which is corresponds to the

theory; where there was stage fear in one case (no: 16), fear of dark and strangers in 1

case (no: 18), fear of thunderstorm in one case (no: 21) fear of opposite sex in one case

(no: 22), fear of exams in 1 case (no: 24), and

Desire for company and consolation is a prominent mental feature of Pulsatilla

found in most of the materia texts and was seen in 6 cases (no: 3, 14, 16, 21, 22 and 24).

Pulsatilla patients are highly senstivie and emotional so that they readily weep. Though

this is one of the main symptoms which make one think of puls, in this study these

symptoms were noticed in only 3 cases (no: 16, 18 and 21). Usually one may not think of

Pulsatilla in a patient who prefers to be alone or who cannot tolerate contradiction. But in

this study these symptoms were also found in patients. Likes to be alone was noticed in

one case (no: 18) where the patient was also irritable which is again not an usual

presentation and does not like contradiction was seen in one case (no: 22)

93

Physicals:

Pulsatilla females are usually inclined to b fleshy. But in this study out of 6 cases,

3 patients were lean (no: 14, 16 and 24) and 4 patients were stocky (no: 3, 18, 21 and 22)

which suggests that Pulsatilla can also be thought in women who are lean. According to

materia texts Pulsatilla patients have profuse or increased perspiration which is noticed in

all the 6 cases in this study and also noticed on different parts of the body. Increased

perspiration on face (no: 3 and 24), on chest and back (no: 16 and 22), on palms and soles

(no: 16) and all over the body (no: 14). Some peculiar cravings which were not noticed

much in materia texts were also noticed here. Craving for spicy (no: 3, 16, 18, 21 and

22), craving for sweets (no: 21, 22), craving for ice cream (no: 14, 16 and 22), craving for

chicken (no: 16 and 22). Mostly Pulsatilla is thermally hot which is noticed in all the

cases except one case (no: 21) which is chilly.

Miasm:

Pulsatilla is predominantly an anti sycotic medicine. In this study, 3 cases (no: 3,

14 and 21) had sycosis as a miasmatic background and 4 cases (no: 16, 18, 22 and 24)

had psoro sycosis as the miasmatic background.

Presenting complaints:

Regarding Pulsatilla female complaints, there will be amenorrhoea or too late,

scanty menses. But here in this study among the 6 cases, only 1 case (no: 3) presented

with amenorrhoea since 8 months where as other cases presented with irregular menses

which again differed in duration; 2 cases (no: 14, 21) presents with irregular menses once

in 2 months, one case (no: 16) presents with irregular menses once in 3 months, one case

94

(no: 18) presents with irregular menses once in 2 – 3 months, one case (no: 22) presents

with irregular menses once in 4 – 6 months, one case (no: 24) presents with irregular

menses once in 40 days. Though the quantity of menses is scanty in Pulsatilla as

mentioned early, only one case presented with scanty flow (no: 22) whereas 4 cases

presented with profuse flow (no: 16, 18, 21 and 24) and the remaining two with normal

flow (no: 3 and 14). 3 cases presented with hirsutism (no: 3, 21 and 22), 2 cases with

increase in weight (no: 3 and 21), one case presented with acne (no: 22) and one case

(no: 21) with infertility.

LYCOPODIUM:

This drug is inert until the spores are crushed. Its wonderful medicinal properties

are only disclosed by trituration and succussion. It belongs to the family Lycopodiaceae.

When triturated and the spores with their dense cellulose covering ruptured, the oil within

them is liberated and an agent of great therapeutic value is liberated. It is usually grown

in the northern countries. It is also known by other names like Wolf’s foot or Club moss.

This medicine is a deep acting, polychrest medicine which is usually prescribed as

constitutional medicine. In nearly all cases where Lycopodium is the remedy, some

evidence of urinary or digestive disturbance will be found. Corresponds to Grauvogl's

carbo-nitrogenoid constitution, the non-eliminative lithæmic.

Mild temperaments of lymphatic constitution, with catarrhal tendencies; older

persons, where the skin shows yellowish spots, earthy complexion, uric acid diathesis,

etc. In this study of Polycystic Ovarian Syndrome, out of 30 cases 4 cases were given

Lycopodium as a constitutional medicine (case no: 11, 15, 23 and 26).

95

Mentals:

Lycopodium personalities are very cowardice and always have a fear to undertake

any new responsibilities and also has marked feature of anxiety. All the four cases had

marked anxiety as one of the mental feature, among which one case had a marked anxiety

to undertake new responsibilities (no: 11), anxiety about health was noticed in one case

(no: 15), anticipatory anxiety in one case (no: 23) and anxiety about exams in one case

Cases 11 15 23 26 Emotional state

Anxiety3 with new responsibilities Self doubt3 regarding her abilities. Better by consolation. Pessimistic

Sympathetic Likes company3

Changeable in decision Consolation amel Anxiety about health.

Reserved, fear of strangers. Anticipatory anxiety3

Anxiety during exams3. Anger easily. Shouts back. Does not speak to that person for few days. Likes company2

Appearance Lean Stocky Lean Lean Perspiration Increased

generally Increased in axilla

Increased on face Increased on upper lip, axilla and face

Desires & aversions

Cr: oily food2, Meat3

Cr: spicy2, fruits Av: milk

Cr: chicken2, spicy2, salty food, sweets2

Nothing significant

Bowel habits Hard Regular Regular Regular Miasm Psoro-sycotic Sycotic Psoro-Sycotic Sycotic Thermal Hot Hot Chilly Hot Physical complaints

Increased hair growth on upper lip and chin since 4-5 yrs Acne on face with pain and pus discharge Irregular menses once in 40 days since 3-4 yrs with abdominal pain

Irregular menses once in 45 – 48 days since 6 – 7 months. Increase in weight more than 5 – 6 kgs

Irregular menses once in 2 months since 1 yr Burning pain in the stomach since 3 months. Frontal headache since 3-4 months

Irregular menses once in 2 months since 5yrs. Menses profuse with clots Pain in back and abdomen during menses. Increased hair growth on upper lip and chin

96

(no: 26). The feature sympathetic is not found much in Lyco text but here it is seen in one

case (no: 15). Regarding the preference of company, Lyco patients prefer company but

not in the same room, they prefer someone in the next room of the house. Though that

kind of feature is not seen here a general desire for company was seen in 2 cases (no: 15

and 26) and better by consolation was noticed in 2 cases (no: 11 and 15). Lycopodium

personalities are those who get angry easily and shout back. But this feature has been

noticed in only one case (no: 26).

Physicals:

Usually Lyco constitutions are lean physically which was noticed in majority of

the cases. Out of the 4 cases 3 cases (no: 11, 23 and 26) were lean and one case (no: 15)

was stocky. Increased perspiration was noticed in all the cases and also mainly in the

axilla (no: 15 and 26), face (no: 23 and 26) and all over the body (no: 11) which are

found in the materia medica text also. Lyco is generally hot. Here also cases were hot

(no: 11, 15 and 26) except one case which was chilly (no: 23). These personalities have a

great desire for sweets but this feature is noticed in only case (no: 23) and some rare

cravings like craving for spicy was noticed in 2 cases (no: 15 and 23), for oily food and

meat in one case (no: 11) and for chicken and salty foods in one case (no: 23).

Miasm:

Lycopodium has all the three miasms in the background with a sycotic

predominance. In this case study two cases had sycosis (no: 15 and 26) and two cases had

psoro – sycosis as a miasmatic background (no: 11 and 23).

Presenting complaints:

The female complaints of Lyco are too late and profuse menses which were seen

as irregular menses in these cases. Out of 4 cases, two cases presented with irregular

97

menses once in 2 months (no: 23 and 25), one case with irregular menses once in 45 – 48

days (no: 15) and one case with irregular menses once in 40 days and profuse menses was

noticed in only one case (no: 26). Two cases also presented with hirsutism (no: 11 and

25), one case with acne (no: 11) and one with increase in weight (no: 15). The very

characteristic symptom of Lyco, the gastric complaints was noticed in only one case

(no: 23).

PHOSPHORUS:

This is a non – metallic element obtained from bones or Calcium Phosphate. It

comes in white waxy cylinders. These are colourless or pale yellow, semi-translucent or

transparent with waxy lustre and consistency at ordinary temperature; odour disagreeable

and tasteless. When exposed to air, it emits white fumes which are luminous in the dark

and have garlicky odour. In this study Phosphorus is prescribed as a constitutional

medicine in 2 cases (no: 5 and 13).

Cases 5 13 Emotional state

Extrovert2 Friendly nature More attached to friends Easily adaptable

Jovial2. Extrovert Helpful. Sympathetic2

Appearance Stocky Lean Perspiration Increased on face and neck Increased on neck and face

Desires & aversions

Cr: ice cream2, chicken

Cr: spicy, fried food Av: sweet

Bowel habits Regular Regular Miasm Psoro-Sycotic Psoro-Sycotic

Thermal Chilly Chilly Physical complaints

Pimples – pustular and painful since 2 – 3 yrs. Itching < oily food Irregular menses once in 42 – 45 days since 2 - 3 yrs. Flow normal. Clots – more

Increased hair growth on face, chin and neck since 2 yrs. Irregular menses once in 45 days with profuse flow and clots. Mild abdominal pain during menses.

98

Mentals:

Phosphorus personalities are very jovial and friendly. They diffuse and mingle

easily with everyone. A kind of anxiety also is present in Phos but that will subside with

reassurance. They also have a preference for need of company and they are highly

sympathetic. In this study also mentally both the cases (no: 5 and 13) were extroverted,

jovial and friendly in nature and sympathetic nature was noticed in one case (no: 13).

Physicals:

Phos is usually indicated in lean and emaciated people with sanguine

temperament. But in this study one case was stocky (no: 5) and one case was lean

(no: 13). Regarding the cravings and aversion, Phos personalities always prefer

something icy cold as their stomach cannot tolerate warm food or drink. This is seen as

craving for ice cream in one case (no: 5) and some features which are not often

encountered like craving for spicy and fried food was noticed in one case (no: 13) and

aversion to sweets which is seen in Phos was noticed in one case (no: 13). Both patients

were thermally chilly and increased perspiration on face and neck was noticed in both the

cases.

Miasm:

Phosphorus has tubercular miasm as the background, but in this study bith the

cases had psoro – sycotic miasm as the miasmatic background.

Presenting complaints: Phosphorus is a great haemorrhagic remedy where there will be

easy tendency for bright red bleeding. Menses too early and scanty-not profuse, but last

too long. But here both the cases had delayed or irregular menses once in 45 days and it

99

was profuse in one case (no: 13) and normal in one case (no: 5). Out of the 2 cases, one

case (no: 5) presented mainly with acne which was pustular and painful one case (no: 13)

presented with hirsutism

SEPIA:

It is prepared from a brownish-black substance and is the dried liquid contained

in the "ink bag" of the cuttle fish. In this study sepia was prescribed as constitutional

medicine in 2 cases (no: 7 and 10).

Cases 7 10 Emotional state

Consolation agg Fear of snakes Emotions suppressed Better after weeping

Indifferent2 towards family members especially husband. Introvert Reserved

Appearance Obese Lean Perspiration Increased on head Increased on face and chest

Desires & aversions

Av: milk2 Nothing significant

Bowel habits Regular Regular

Miasm Sycosis Sycosis

Thermal Chilly Chilly

Physical complaints

Irregular menses once in 2 months since 3 yrs Scanty flow with clots and severe abdominal pain Increase in weight 15 – 20 kgs in two years

Amenorrhoea since 10 months with mild abdominal pain and scanty flow

100

Mentals:

Emotionally Sepia is very indifferent to the loved ones and dreads to be alone.

They have aversion to work. Irritable and easily offended. Typical indifference towards

husband was noted in one case (no: 10) and also the patient was reserved. The typical

aggravation from consolation was noticed in one case (no: 7).

Physicals:

Usually Sepia is adapted to tall, lean women with male type pelvis. But in this

study obesity was noticed in one case (no: 7) and the other case was lean (no: 10). Sepia

personalities have increased perspiration which was noticed in both the cases and there

were no marked desires and aversions. According to the Materia Medica text Sepia is

thermally chilly and in this study also both the cases were chilly.

Presenting complaints:

The female complaints of Sepia are of various types; menses too late and scanty,

irregular; early and profuse. One case (no: 7) presented with irregular menses once in 2 –

3 months and one case (no: 10) presented with amenorrhoea since 10 months. Both the

cases presented with scanty flow.

Discussion

101

DISCUSSION

Polycystic ovarian syndrome is one of the commonest gynaecological problems

especially affecting the young girls mainly the students. It has become highly prevalent

due to the various stresses encountered in the modern life. Stress is seen in various

aspects of life, in inter-personal relationship, area of work, financial matters etc. This may

have further complications like diabetes, infertility etc.

This study was conducted on the patients who attended the OPD in Fr. Muller

Homoeopathic Medical College at Kankanady and Deralakatte. The patients between the

age group of 15 – 30 yrs were selected for the study. Patients who belong to different

socio – economic groups were taken as per inclusion criteria. A total of 30 cases were

selected. Minimum duration of study was 3 – 6 months. The statistical analysis made here

is based on the data obtained from above 30 cases.

All the different modes of treatment have only helped in a palliative or

suppressive way. Homoeopathic mode of treatment is superior to other modes or

treatment since it treats not the effects but the causes. It is the man who is sick and not his

body and as a matter of fact he needs to be treated. It is here the concept of

individualization comes into practice, where the physical as well as the mental

characteristics of the individual is taken.

Considering the psychosomatic relationship in polycystic ovarian syndrome, there

arises a necessity for a detailed case taking which helps a physician to arrive at a

psychological profile which helps in person diagnosis, disease diagnosis and management

of case, both specific as well as general.

102

Here the concepts of individualization and susceptibility are to be considered.

Usually the susceptibility depends on the degree of correspondence and hence greater the

number of characteristics at the mental and physical level, greater is the susceptibility and

higher the potency. Therefore a study has been taken to evolve a suitable homoeopathic

approach in the effective management of polycystic ovarian syndrome.

30 cases which were diagnosed as “Polycystic Ovarian Syndrome” as per strong

clinical presentation and also ultrasonographic evidence in some cases was taken up for

the study and all the cases were followed up to a minimum of 3 – 6 months. Patients

included in this study are from 15 – 30 yrs. Maximum prevalence was noticed in the age

group 20 – 25 yrs, 13 (43.33%) cases.

Out of 30 cases, significant preponderance of 16 (53.33%) cases were seen among

Hindu population, 8 cases (26.67%) were Muslims and 6 cases (20%) were Christians in

the study population.

Out of 30 cases, 16 (53.33%) patients were students, 4 (13.33%) cases were beedi

rollers, 6 (20%) patients were house wife, 2 (6.67%) were teachers and 1 (3.33%) each

were tailor and official. According to the study, polycystic ovarian syndrome was more

commonly seen in students.

The clinical presentation varied in different cases. Regarding irregularity of

menses, irregular menses once in 20 days was present in 1 case (3.33%), irregular menses

once in 40 – 45 days was present in 11 cases (36.67%), irregular menses once in 2

months was present in 9 cases (30), irregular menses once in 3 months was present in 4

cases (13.33%), irregular menses once in 4 months was present in 2 cases (6.67%) and

103

amenorrhoea was present in 3 cases (10%), weight gain was present in 6 cases (20%),

hirsutism was present in 9 cases (30%), acne in 8 cases (26.67%), scanty menstrual flow

was noticed in 6 cases (20%), profuse flow in 11 cases (36.67%) and infertility in 2 cases

(6.67%).

Usually according to the literature one of the clinical features of PCOS is

oligomenorrhoea which means scanty menses, but here in this study a maximum of 11

cases (36.67%) had complaints of profuse menses which is not found in the literature

much and also only 6 cases presented with weight gain and some patients were lean

which is again in contrary to the literature. From this we can conclude that the

presentations can be in the other way also. The other clinical presentations were agreeing

with the literature.

Considering the miasmatic background diagnosis of the patients, Sycosis was

found as the most dominating, though cases with Psora and Psoro - Sycosis were also

encountered. The dominant miasmatic expressions seen in this study was Sycosis in 16

cases (53.34%), Psoro – Sycotic was marked in 13 cases (43.33%) and Psoric expression

was well marked in 1 case (3.33%). This confirms with the observation of stalwarts like

Dr Hahnemann, Dr Harimohan Choudhury, Dr Phyllis Speight who have found the

Sycotic element predominant in Polycystic Ovarian Syndrome.

Out of 30 cases selected, all the cases were given constitutional remedies. 14

cases were given only constitutional medicines, 11 cases were treated with constitutional

medicine along with inter current remedy, 5 cases were treated with medicines that

follow well the constitutional medicine and 2 cases also received sector remedy along

with constitutional and intercurrent remedy. The sector remedies that were used in this

104

study are Apis and Jonosia. The anti miasmatic medicines used were Thuja, Sulphur and

Medorrhinum were given. Natrum mur was prescribed as a constitutional remedy in 10

cases (33.33%), Pulsatilla was prescribed as constitutional remedy in 7 cases (23.33%),

Lycopodium was prescribed as a constitutional remedy in 4 cases (13.33%), Phosphorus

and Sepia were prescribed as constitutional remedy in 2 cases each (6.66%), Graphities,

Ignatia, Silicea, Calcarea carb and Lachesis were prescribed as constitutional remedies in

1 case each (3.33%).

Though some of the remedies have been given to two or more cases it may not be

concluded that only these medicines can be given to any case of PCOS, because the

prescription finally depends upon each case on the basis of individualization.

Out of 30 cases, 200th potency was used in maximum number of cases 9 cases

(30%) during the beginning of the treatment but by the end of the treatment, 1M potency

was used in maximum number of cases i.e. 15 cases (50%).

Some cases demanded the use of antimiasmatic remedy whereas others did not.

This shows the variation from individual to individual though the disease is same. To

conclude, the medicine and potency selection varies from case to case depending upon

the presentation and various other factors thus fulfilling the concept of individualisation.

The follow up criteria was mainly based upon the general improvement, regularity

of menses, reduction in weight and reduction in other symptoms like acne, hirsutism,

abdominal or back pain. The totality was carefully been selected according to the severity

of complaints and the need of the case. Chronic totality was put up considering the basic

constitution of the person and attributes during the complaints.

105

According to the literature mentioned about case taking, a proper one will not

only help in arriving at a similimum, but also has a therapeutic effect. A proper case

documentation has to be done simultaneously as symptomatic classification and

evaluation; clinico pathologic as well as psychological correlation can be obtained.

Therefore the final outcome of the study after treatment was 25 cases (83.33%)

showed good improvement, 3 cases (10%) did not show improvement and 2 cases

(6.66%) were dropped out from the study because of the discontinuation of the treatment.

Homoeopathy gives more importance to psychosomatic aspect, so method of case

taking and remedy selection will suit to psychosomatic diseases in general and polycystic

ovarian syndrome in particular. As individual variations in the presentation of clinical

conditions are extended into therapeutic management as well, “Homoeopathic

treatment is effective in the treatment of patients suffering from Polycystic Ovarian

Syndrome”.

Conclusion

106

CONCLUSION

These are the findings of the study of Polycystic Ovarian Syndrome:

1. Prevalence of Polycystic Ovarian Syndrome is comparatively more in the age group

20 – 25 yrs, (43.33%).

2. Prevalence of Polycystic Ovarian Syndrome is found more among students (53.33%)

3. Prevalence of Polycystic Ovarian Syndrome is found more in Hindu religion

(53.33%).

4. Constitutional treatment seems to be efficacious.

5. Constitutional remedies like Natrum mur (33.33%), Pulsatilla (23.33%),

Lycopodium (13.33%), Phosphorus and Sepia each (6.66%), Graphities, Ignatia, Silicea,

Calcarea carb and Lachesis (3.33%) were indicated.

6. Sycosis dominance was noted in majority of the cases (53.34%).

7. 200th potency was used in maximum number of cases 9 cases (30%) during the

beginning of the treatment but by the end of the treatment, 1M potency was used in

maximum number of cases i.e. 15 cases (50%)

8. Majority of the patients included in this study group showed a significant

improvement after homoeopathic treatment.

9. The statistical scales used for the assessment of the effect of the treatment also

showed significant improvement after the treatment.

107

LIMITATIONS

1. This is a restricted sample design, in which only 30 cases were studied. So chances of

sampling error are increased with small sample size.

2. No control group was maintained to assess the effectiveness.

3. Few of the cases did not have regular follow up, so assessment of drug action could

not be controlled well.

4. To minimize the variations in physicians’ actions, proper planning on the part of

primary physician is demanded.

5. Since this is a time bound study, cases could not be studied for longer period. Some

good cases couldn’t be considered in this study because of discontinuation of treatment.

6. Since the study was based on subjective evaluation of patients before and after

treatment, objective parameters like ultrasound, hormonal assay etc were not done. The

improvement is based only on clinical symptoms and examination; hence the results

could not be substantiated after treatment.

RECOMMENDATIONS:

1. Universal standardized scale for assessing the symptoms should be used, so that

evaluation of outcome of the study would become precise.

2. Bigger sample with extended time of research would provide better result

3. It will be always scientific to keep control (placebo) group simultaneously to verify

the effectiveness of treatment.

4. Reliable laboratory based diagnosis and evaluation of outcome gives more credibility

for the study.

Summary

108

SUMMARY

A total of 30 cases were selected for the study based on inclusion and exclusion

criteria. These cases were followed regularly and at the end of the study there were

certain conclusions arrived at.

In this study maximum numbers of cases were in the age group 20 – 25 yrs, 13

cases (43.33%). Out of 30 cases selected, the maximum prevalence of cases was noted

among the Hindu religion, 16 cases (53.33%). Regarding the occupation, the maximum

number of cases of PCOS prevailed among the students, 16 cases (53.33%). Out of 30

cases, 16 cases (5.33%) were having Sycotic miasm as the dominant miasm.

All the cases were treated with constitutional medicine, 14 cases were given only

constitutional medicines, 11 cases were treated with constitutional medicine along with

inter current remedy, 5 cases were treated with medicines that follow well the

constitutional medicine and 2 cases also received sector remedy along with constitutional

and inter current remedy. 83.33% cases showed improvement. The most indicated

constitutional remedy was Natrum mur. The next most indicated remedy was Pulsatilla

and other indicated remedies include Lycopodium, Phosphorus, Sepia, Graphities,

Silicea, Ignatia, Calcarea carb and Lachesis. In this study 200th potency was selected for

the first prescription in maximum cases and at the end of treatment 1M potency was used

in a maximum of 15 cases.

Thus the study revealed that Homoeopathic treatment is effective in the

management of patients suffering from Polycystic Ovarian Syndrome.

Bibliographic References

109

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Annexures

114

ANNEXURE 1

SCORING CRITERIA FOR EVALUATING THE INTENSITY OF

SYMPTOMS IN PCOS

Symptom Severity Score 1. Character of menses

Amenorrhoea Irregular once in 2-3 months Irregular once in 40-45 days Irregular once in 20 days Regular

4 3 2 1 0

2. Pain (Dysmenorrhoea)

Severe Moderate Mild Nil

3 2 1 0

3. Character of flow Profuse Spotting Scanty Moderate

3 2 1 0

4. Clots More

Slightly present

Absent

2

1

0

115

Symptom Severity Scores 5. Acne Severe

Moderate Mild Absent

3 2 1 0

6. Weight gain Moderate (more than10 kgs) Mild (less than10kgs) Absent

2 1 0

7. Hirsutism Severe Moderate Mild Absent

3 2 1 0

116

ANNEXURE – II

DETAILED CASE STUDY

PRELIMINARY DATA

Name : Ms. L SCR No. : 53636

Age : 21 yrs Date : 20-08-2009

Sex : F Physician : Dr. PK

Occupation : Student

Education : B. Com

Address : Sakthi Nagar

CHIEF COMPLAINT

No LOCATION SENSATION MODALITY CONCOMITANT

1. FGT

Since 1 yr

FMP: 11 yrs of age

LMP: 18/7/2009

Irregular menses once in 40 – 45 days

Profuse flow.

Clots – slightly present

Bleeding brown in colour.

-------- Increase in weight more than 6kgs

Moderate lower abdominal pain during menses.

Eruptions around the neck

117

HISTORY OF PRESENTING COMPLAINTS:

Patient was apparently well I year back when she developed irregular menses. She

used to get delayed cycles which is once in 40 – 45 days. The flow used to be profuse

with two or three clots and moderate lower abdominal pain during menses. The colour of

the flow used to be brown. There is associated history of weight gain of more than 6 kgs

No LOCATION SENSATION MODALITY CONCOMITANT

2. Head since 1 yr.

Frontal, occipital and vertex.

Sudden onset and sudden disappearance

Heaviness2

Sensation as if pressed

< morning after waking

< evenings after class

< stooping forward

> sleep

No nausea/ vomiting

No vision disturbance

Weakness

Irritated when hearing sounds

3. RS

Nose

On and off since 1 yr

Sneezing2

Coryza stopped

(has to blow hard; whitish, scanty)

< morning

< dust

Itching of eyes

Throat irritation

4. Head.

Scalp since 7 – 8 months

Dandruff

Cream – like

Oily.

Itching

< head bath Hair fall

118

in one 7 – 8 months and there is no history of acne or abnormal hair growth (hirsutism).

Patient also complains of heaviness and pressing sensation in thee frontal, occipital and

vertex region which is worse in morning and evening and also by stooping and better by

sleep. There is associated weakness and irritability for noise. She also complains of

sneezing with coryza and itching of eyes < dust and in morning since 1 yr. Patient

complains of dandruff since 7 -8 months which is creamy white and very oily with

itching and hair fall worse after head bath.

PAST HISTORY:

Nothing significant

FAMILY HISTORY:

Maternal uncle: Diabetes

PATIENT AS A PERSON:

Appearance – Stocky

Diet – Non veg

Appetite – Good

Thirst – good, 1½ to 2 lts/ day

Craving – Chocolates2, ice cream2, Salty food2

Aversion – Sweets

Bladder habits – Regular, 4-5 times/day; once/night

119

Bowel habits – Regular, once/day

Perspiration – Increased generally

Sleep – Good

Thermal state – Hot

Menstrual History:

FMP – 11 yrs

LMP – 18/7/09

Irregular cycles, once in 40 – 45 days

Duration – 5 to 6 days

Profuse flow, brown and clots present

Leucorrhoea – occasionally

LIFE SPACE INVESTIGATION:

The patient hails from a middle class family of 2 children where she is the eldest.

She has a younger brother who is studying 1st year in college. She has a good relation

with her family. She shares her difficulties with her mother. She is studying in St. Agnes

presently doing her final year degree. She finds college nice and is happy. She is friendly

in nature. She does not like it when someone blames her without any reason or shouts at

her. She will get angry if a work of the day is not finished. She gets irritated when angry.

She prefers to be alone and gets irritated if someone comes to console her.

120

She does not keep the anger for long. She will forget it is sometime. She will not

express if she is very upset. She shouts at her brother if he troubles her. She has many

friends but she is closed only to a few. She has no particular restrictions at home and her

parents are not very strict. She likes roaming about and shopping.

GENERAL PHYSICAL EXAMINATION:

Patient is moderately built and moderately nourished.

Well oriented with time, place and persons.

No signs of pallor, cyanosis, clubbing, icterus, oedema or lymphadenopathy

Vital signs:

Temperature – 98.6º F

Blood pressure – 122/80 mm of Hg

Pulse rate – 72 beats/min, regular, good volume

Respiratory rate – 16/min

SYSTEMIC EXAMINATION:

Respiratory system – NAD

Cardio – vascular system – NAD

Per abdomen – NAD

Central nervous system – NAD

Sinuses – Non tender

121

PROVISIONAL DIAGNOSIS:

Polycystic ovarian syndrome:

Obesity

Irregular menses

Menorrhagia

Tension type headache:

Heaviness

Sensation as if pressed

Occipital region

Allergic rhinitis:

Sneezing < morning and dust

Coryza with throat irritation

Itching of eyes.

DIFFERENTIAL DIAGNOSIS:

Hypothyroidism:

Obesity

Menstrual irregularity

R/O No history of cold intolerance/ constipation and other features of hypothyroidism.

Sinusitis:

Heaviness < stooping

Nasal discharge +

R/O sinuses are non – tender

122

INVESTIGATIONS:

Ultrasound abdomen and pelvis:

Dated: 5/9/09, Multiple peripheral follicles seen in the ovaries

Impression: Polycystic Ovaries

CHRONIC CONSTITUTIONAL TOTALITY:

Mental generals:

Anger when scolded unnecessarily

Weeping when alone

Sensitive

Anger when day’s work is not completed

Fastidious

Likes to be alone

Consolation <

Physicals generals:

Appearance – Stocky

Perspiration – Increased

Craving – Chocolates, Ice cream, Salty food

Aversion – sweets

Thermal state – Hot

Particulars:

1. FGT:

Irregular menses once in 40 – 45 days

Profuse flow

123

Lower abdominal pain

Clots+

Increase in weight

2. Head:

Heaviness

Sensation as if pressed

< morning and evening

3. Nose:

Sneezing < morning

Itching of eyes and throat irritation

4. Head:

Dandruff – Creamy white

Oily

Hair fall

Itching

Indicated remedy: Natrum mur

Differential remedy: Calcarea carb

Sensitive

Obese

Perspiration increased

Aversion – sweets

Desire – chocolate

Menses delayed

R/O – Calc carb is chilly but the patient is hot and also doesn’t like company

124

INTERCURRENT TOTALITY:

FM: Sycosis

DM: Sycosis

Rx: Medorrhinum

Structure: Ovaries; Graafian follicles

Function: Form:

Ovarian enlargement Sensitive, Consolation <

Hormonal imbalance Weeping when alone

Menstrual dysfunction Fastidious

Increased production of androgens Prefers to be alone

Perspiration increased

Cr: chocolates, ice cream, salty

food

Av: sweets

Thermal: Hot

Irregular menses once in 40-45

days

Profuse flow with clots

Dysmenorrhoea; weight gain

PCOS

Since 1 yr

125

Structure: Skeletal muscles of head

Function: Form

Muscle contraction Sensitive, Consolation <

Weeping when alone

Fastidious

Prefers to be alone

Perspiration increased

Cr: chocolates, ice cream, salty

food

Av: sweets

Thermal: Hot

Pressive pain; heaviness

Tension type Headache since 1 yr

126

Structure: Nasal mucosa

Function: Form: Sensitive, Consolation <

Increased secretion of chemical mediators Weeping when alone; Fastidious

Allergic reactions Prefers to be alone

Inflammation Perspiration increased

Cr: chocolates, ice cream, salty

food

Av: sweets

Thermal: Hot

Sneezing < morning, dust

Itching of eyes and throat

Irritation

Allergic rhinitis

Since 1 yr

127

PLANNING AND PROGRAMME:

Define with reasons the states Potency-choice Repetition

1. Susceptibility: High 200 Infrequent

2. Sensitivity (Mind and Nerves): High 200 Infrequent

3. Suppressions: Nil 200 Infrequent

4.Correspondence (Constitutional medicine):

Complete

200 Infrequent

5. Correspondence (Intercurrent medicine):

Complete

200 Infrequent

6. Functional changes: Present 200 Infrequent

7. Structural changes: Present 30 – 200 Frequent

8.Fundamental miasm: Sycosis 30 – 200 Infrequent

9. Dominant miasm: Sycosis 30 – 200 Infrequent

FOLLOW UP CRITERIA:

1. Regularity of menses

2. Menses flow

3. Weight

4. Headache

5. Sneezing

6. Dandruff

7. Hairfall

128

FIRST PRESCRIPTION: 20.08.09

Rx: 1. Bryonia 30; 4 – 0 – 0 (for acute headache)

2. 3 grain tab 0 – 1 – 1 X 1 week

GENERAL MANAGEMENT:

Avoid fried and oily food to reduce the weight

Avoid stress and tension

Advised to do meditation.

Avoid exposure to dust.

PROGRESS NOTES:

Date Symptom changes Interpretation Prescription

27.08.09 1 2 3 4 5 6 7 Medicine

selected was not

acting

Rx:

1. Natrum mur 200 (1P)

HS

2. 3 gr tab

1 – 1 – 0

3. SL

0 – 0 – 1 X 2 weeks

S S S S S S S

Complaints not better

Sleep – increased

LMP – 18/7/09

BP: 122/80 mm of Hg

Other generals - good

Date Symptom changes Interpretation Prescription

24.09.09 1 2 3 4 5 6 7 Remedy is the

similimum

Expectation:

Further

improvement

since continued

amelioration

Rx:

1.Natrum mur 1M (1P)

HS

2. 3 gr tab

1 – 1 – 0

3. SL

0 – 0 – 1

X 2 weeks

> > S > > > S

Complaints were better

LMP: 28/08/09. Duration – 4 to 5

days. Clots present.

Sneezing restarted since 1 week

Generals: Good. Wt: 77 kgs.

USG (5.9.09): Polycystic ovaries

129

Date Symptom changes Interpretation Prescription

15/10/09 1 2 3 4 5 6 7 Better only when

taking medicine.

So medicine need

to be repeated

Expectation:

Further

improvement

Rx:

1. Natrum mur 1M

(1P)

HS

2. 3 gr tab

1 – 1 – 0

3. Bell 200 (SOS)

X 2 weeks

> > ↓ > > > S

Complaints were better with previous

medication

LMP: 26/09/09. Duration – 4 to 5 days

No Clots.

Headache and sneezing better

Weight: 76 kgs; BP: 120/78 mm Hg

Generals good

Date Symptom changes Interpretation Prescription

29.10.09 1 2 3 4 5 6 7 Remedy’s action

ceased after initial

improvement. So rise

in potency is needed

Expectation:

Further improvement.

Rx:

1. Natrum mur 10M

(1P) HS

2. No ii pills

4 – 0 – 0

3. 3 gr tab

1 – 1 – 0

X 1 month

> > S > > > S

Complaints are better

Menses delayed; LMP: 26/09/09

Weight: 77 kgs

Generals: Good

Date Symptom changes Interpretation Prescription

26.11.09 1 2 3 4 5 6 7 Remedy’s action

ceased after initial

improvement. So

rise in potency is

needed

Expectation:

Further

improvement

Rx:

1. Natrum mur 10M

1 – 0 – 0

2. 3 gr tab

1 – 1 – 0

X 2 weeks

S > S A A > S

Complaints were better

LMP: 26/09/09had lower abdominal

pain 2 days back now better.

Running nose < morning on waking;

no sneezing. No throat pain and

headache

Weight: 77 kgs;

Generals: good

130

Date Symptom changes Interpretation Prescription

10/12/09 1 2 3 4 5 6 7 Remedy’s action

ceased after

initial

improvement. So

rise in potency is

needed

Expectation:

Further

improvement

Rx:

1. Natrum mur 0/1

HS

2. No ii pills

4 – 0 – 0

3. 5 gr tab

0 – 0 – 1

X 2 weeks

S > S A A > S

After taking previous medicine menses

occurred for 5 days. LMP: 30/11/09

Pt feels discomfort in opening eyes

since 4 days. Watering of eyes

Weight: 77 kgs;

Generals: good

Date Symptom changes Interpretation Prescription

14.01.10 1 2 3 4 5 6 7 Need of acute

medicine as the

complaints are

severe Expectation:

Further

improvement

Rx:

1. Bell 200

4 – 0 – 0

2. SL

0 – 0 – 1

X 1 week

S > S ↑ ↑ > S

Headache increased since 3 – 4 days.

Squeezing type of pain in the vertex <

morning. Coryza and sneezing for 1 week.

Date Symptom changes Interpretation Prescription

21.01.10 1 2 3 4 5 6 7 Remedy’s action

ceased inspite of

rise in potency.

There is a need

of follow well

remedy

Expectation:

Further

improvement

Rx:

1. Calc carb 1M

HS

2. No ii pills

4 – 0 – 0

3. 5 gr tab

0 – 0 – 1

X 2 weeks

S > S A A > >

Complaints were better

LMP: 14/01/10 duration: 5 days. Clots

present.

Generals: good

131

Date Symptom changes Interpretation Prescription

04.02.10 1 2 3 4 5 6 7 Repetition is

needed

Expectation:

Further

improvement

Rx:

1. Calc carb 1M

HS

2. No ii pills

4 – 0 – 0

3. 5 gr tab

0 – 0 – 1

X 2 weeks

S > S ↑ A > >

LMP: 14/01/10.

Generals: good

Date Symptom changes Interpretation Prescription

25.02.10 1 2 3 4 5 6 7 Repetition is

needed

Expectation:

Further

improvement

Rx:

1. Calc carb 1M,

HS

2. No ii pills

4 – 0 – 0

3. 5 gr tab

0 – 0 – 1 X 2 weeks

> > S A A > >

Complaints were better

LMP: 21/02/10

Flow: normal; No clots

Generals: good

Date Symptom changes Interpretation Prescription

11.03.10 1 2 3 4 5 6 7 Repetition is

needed

Expectation:

Further

improvement

Rx:

1. Calc carb 1M

HS

2. No ii pills

4 – 0 – 0

3. 5 gr tab

0 – 0 – 1

X 2 weeks

> > S A A > >

Complaints were better

LMP: 21/02/10

Generals: good

132

Date Symptom changes Interpretation Prescription

22.04.10 1 2 3 4 5 6 7 Repetition is needed

Expectation:

Further

improvement

Rx:

1. Calc carb 1M

HS

2. No ii pills

0 – 0 – 4

3. 3 gr tab

1 – 0 – 0

X 2 weeks

> > S A A > >

Complaints are better

LMP: 20.04.10

Generals: good

Date Symptom changes Interpretation Prescription

1.7.10 1 2 3 4 5 6 7 Repetition is

needed

Expectation:

Further

improvement

Rx:

1. Calc carb 1M

HS

2. 1 gr tab

4 – 4 – 0

3. SL

0 – 0 – 1 X 2 weeks

> > S A A > >

Complaints were better

LMP: 14/06/10

Flow: normal; No clots

Generals: good

Date Symptom changes Interpretation Prescription

05.08.10 1 2 3 4 5 6 7 Repetition is

needed

Expectation:

Further

improvement

Rx:

1. Calc carb 1M (1P)

HS

2. No ii pills

4 – 0 – 0

3. 5 gr tab

0 – 0 – 1

X 2 weeks

> > S A A > >

Complaints were better

LMP: 15/07/10

Flow: normal; No clots

Generals: good

133

Date Symptom changes Interpretation Prescription

9.9.10 1 2 3 4 5 6 7 Repetition is

needed

Expectation:

Further

improvement

Rx:

1. Calc carb 1M/ 2P

HS; 1P monthly

2. No ii pills

4 – 0 – 0

3. 3 gr tab

0 – 0 – 1

X 2 months

> > ↓ A A > >

Complaints were better

LMP: 17/08/10

Flow: normal; No clots

Generals: good

Wt: 76 kgs

Date Symptom changes Interpretation Prescription

25.11.10 1 2 3 4 5 6 7 Repetition is

needed

Expectation:

Further

improvement

Rx:

1. Calc carb 1M (1P)

HS

2. No ii pills

4 – 0 – 0

3. 3 gr tab

0 – 0 – 1

X 1 month

> > ↓ A A > >

Complaints are better

LMP: 26/10/10 (22/09/10)

Flow: normal; No clots. Mild lower

abdominal pain during the first day

which stays for one to two hours

Generals: good, Wt: 75 kgs

Date Symptom changes Interpretation Prescription

27.1.11 1 2 3 4 5 6 7 Repetition is

needed

Expectation:

Further

improvement

Rx:

1. SL 1P

HS

2. No ii pills

4 – 0 – 0

3. 3 gr tab

0 – 0 – 1

X 1 month

> > ↓ A A > >

Complaints were better

LMP: 12.1.11 (previous: 10.12.10)

Flow: normal; No clots

Generals: good

Wt: 74 kgs

USG (25.12.10): No significant

sonological abnormality

134

135

136

137

138

LEARNING SESSION RECORD.

CASE CONCEPT.

Patients Name: Miss. L SCR NO: 53636

Clinical Diagnosis: Polycystic Ovarian Syndrome Date: 20.08.2009

Remedy: Acute-

Chronic- Natrum Mur Intercurrent-

A. PROBLEM DEFINITION:

1. INTERVIEW TECHNIQUE.

Direct confrontation technique was used.

Data was elicited by active interaction

which included questioning, careful

listening, skilled interpretation and

sensitive analysis of the case at hand.

Good rapport was established between

physician and the patient.

2. CLINICAL RECORD.

The data got by case taking was

systematically recorded in the SCR

format starting with the chief

complaints, physical generals, past

history, family history, investigations

and life space details.

139

B. CORRELATIONS

3. SYMPTOMATIC: CLASIFICATION AND EVALUATION

4. CLINICO-PATHOLOGICAL

5.PSYCHOLOGICAL

Symptoms were classified and

evaluated as per Kent’s

philosophy:

Mental generals

Physical generals

Characteristics

PCOS with irregular

menses and weight

gain.

Tension headache

with sensation of

heaviness and

pressing in the head

Allergic rhinitis with

sneezing and itching

in the throat and

eyes.

6. HAHNEMANNIAN MIASMATIC PATHOLOGY: CURRENT

INTERPRETATIONS.

Fundamental miasm: .Sycosis ----- Maternal uncle: Diabetes

Dominant miasm: Sycosis.

140

B. ANALYSIS AND SYNTHESIS

7. ACUTE

TOTALITIES.

8. CHRONIC TOTALITIES. 9. INTERCURRENT

TOTALITIES.

Mental generals:

Anger when scolded unnecessarily

Weeping when alone

Sensitive

Anger when day’s work is not

completed

Fastidious

Likes to be alone

Consolation <

Physicals generals:

Appearance – Stocky

Perspiration – Increased

Craving – Chocolates, Ice cream, Salty

food

Aversion – sweets

Thermal state – Hot

FM: Sycosis

DM: Sycosis

141

Characteristics:

Irregular menses once in 40 – 45 days

Sensation in head as if pressed

< morning and evening

Sneezing < morning

Dandruff – Creamy white

10.SEQUENTIAL

TOTALITIES

Not considered

11. SPLIT

TOTALITIES

Not considered

12. RELATED

TOTALITIES

Not considered

13. TECHNIQUES: REPERTORIAL 14. TECHNIQUES: NON

REPERTORIAL

Case was repertorised using synthesis repertory

with mental generals, physical generals, and

characteristic particulars and constitutional

remedy was selected with reference to materia

medica

142

C. PROBLEM STRUCTURALISATION

ESSENTIAL EVOLUTIONARY TOTALITY

Family: Good Predisposition Family: Good

Society: Good FM: Sycosis Society: Good

Work: Good DM: Sycosis Work: Good

Anger when scolded

Weeping alone; Sensitive

Fastidious

Likes to be alone

Consolation <

Perspiration: increased Characteristic particulars:

Cr: Chocolates, ice cream, 1. Menses too late, brownish

salty food 2. Head: heaviness and

Av: sweets sensation as if pressing <

morning

Polycystic ovarian syndrome 3. Nose: sneezing < morning

Tension type headache 4. Head: Dandruff creamy

Allergic rhinitis white

M

I

N

D

B

O

D

Y

DISEASE

DIATHESIS

DISPOSITION

143

D. PROBLEM RESOLUTION

15. MANAGEMENT:

GENERAL

ENVIRONMENT.

16. MANAGEMENT:

GENERAL INDIVIDUAL.

17. MANAGEMENT:

GENERAL

REPLACEMENT.

Assurance to the patient.

Adequate nutritious food.

Regular exercise to reduce

the weight.

Avoidance of fatty and oily

food to reduce the weight.

18. MANAGEMENT: MECHANICAL MEASURES AND ANCILLARY

MEASURES: -----

19. MANAGEMENT: SPECIFIC HOMOEOPATHIC PLANNING AND

PROGRAMING:

The patient presented with prominent mental and physical generals and so

similimum was selected based on this totality that is based on Kentian totality. An inter

current was thought of in case of any miasmatic block.

144

REMEDY SELECTION POTENCY SELECTION REPETITION

SCHEDULE

Natrum mur

(Constitutional) deep

acting and covering

miasmatic aspect also.

200 – 10M; 0/1

ascending potency

1Powder-one dose once in 2

week initially and later once

in one or two months.

Infrequent repetition based

on high sensitivity

PLACEBO ADMINISTRATION: Placebo was given for adequate spacing and

psychological support of the patient.

REMEDY RESPONSE: The totality was clear; hence the constitutional remedy was

administered. Gradual improvement of the disease with final cure of the condition.

REMEDY REGULATION: Natrum mur 200 – 10; 0/1M Powder- Bedtime one dose

once in 2 weeks initially and later once in 1 – 2 months was administered followed by

Calc carb 1M which was given as a follow well. Drastic improvement was noted.

PALLIATION: Nil.

CURE: Natrum mur was selected on basis of constitution and patient showed

tremendous improvement in symptoms with complete cure of the condition.

SUPRESSION: Nil.

HERINGS LAW OF CURE: Not considered

145

20. PROGNOSIS:

As patient is responding to medication well the prognosis is favourable.

E. EDUCATION AND TRAINING:

Importance and relevance of psycho-pathological correlation, in understanding as

well as management of the case. Proper assessment of the susceptibility and sensitivity is

essential in remedy regulation.

Treatment of diseases like polycystic ovarian syndrome requires a wholistic

approach and not an approach with just the name of the disease. Homoeopathic case

taking and constitutional treatment made a significant improvement in the patient. It

shows beneficial action of homoeopathic remedy and its curative capacity in cases of

PCOS, when selected based on sound philosophy.

146

CASE CONCEPT EXPOSITION

Patient’s Name: Miss. L

1. Clinical diagnosis:

a. Polycystic Ovarian Syndrome

b. Tension type Headache

c. Allergic Rhinitis

Remedy: Chronic: Natrum mur

Follow well: Calc carb

2. Remedy diagnosis

As the case had prominent mental and physical generals, a similimum was

selected based on the constitutional totality. Natrum mur was selected as the similimum.

As the susceptibility, sensitivity was high with presence of structural changes moderate

potency was considered i.e 200 and later the potency was increased accordingly. Calc

carb 1M was given as a follow well and considerable improvement was observed.

A. PROBLEM DEFINITION

1. Interview technique :

Direct confrontation technique was used. Data was elicited by active interaction

which included questioning, careful listening, skilled interpretation and sensitive analysis

of the case at hand. Good rapport was established between physician and patient.

147

2. Clinical records:

The clinical record demonstrates the importance of recording the chief complaints

and life space in detail so that we will be able to come to a proper clinical diagnosis.

Chief complaints, past history, mental and physical generals and examination results were

simultaneously recorded under relevant pages of SCR during the interview.

B. CO-RELATIONS :

3. Symptomatic classification and evaluation:

Based on the hierarchy of symptoms, importance was given to the qualified

mentals followed by physical generals and characteristic particulars. Qualified mentals

like anger when scolded unnecessarily, weeping when alone, sensitive, fastidious, likes to

be alone and consolation <; physical generals like perspiration – increased, craving –

chocolates, ice cream, salty food, aversion – sweets and thermally hot and characteristics

like irregular menses once in 40 – 45 days, sensation in head as if pressed < morning and

evening, sneezing < morning and dandruff – creamy white were considered.

4. Clinico-pathological:

Cystic ovarian lesions which clinically expressed as irregular menses with

increase in weight and some eruptions around the neck and also the allergic rhinitis which

expressed as sneezing worse in the morning and the tension headache which expressed as

sensation of pressing and heaviness in the head.

5. Psychological:

Nil

148

6. Hahnemannian Miasmatic Pathology:

In a case, fundamental miasm (FM) is identified based on family history and past

history. But in this case only the maternal uncle is diabetic. Just based on this we may

assess that the patient is having sycosis as a fundamental miasm. Dominant miasm was

derived as Sycosis based on the symptoms of irregular menses, weight gain and also on

the pathology where there is multiple cyst formation in the ovaries.

C. ANALYSIS AND SYNTHESIS

1. Chronic Totality:

Mentals:

Anger when scolded unnecessarily

Weeping when alone

Sensitive

Anger when day’s work is not completed

Fastidious

Likes to be alone

Consolation <

Physicals generals:

Appearance – Stocky

Perspiration – Increased

Craving – Chocolates, Ice cream, Salty food

Aversion – sweets

Thermal state – Hot

149

Particulars:

Irregular menses once in 40 – 45 days

Heaviness and Sensation in the head as if pressed < morning and evening

Sneezing < morning

Dandruff – Creamy white

2. Technique: Repertorial

Case was repertorized by using Kent’s methodology with qualified mentals,

physical generals and characteristic particulars and constitutional remedy was selected

with reference to Materia medica.

3. Problem Structuralisation

Structuralisation of patient’s problem was done using EET. Fundamental miasm

was recorded in predisposition column, mental generals under dispositions column,

characteristic symptoms along with the diagnosis and relevant co – relations of the past to

the present with interpersonal relations.

D. PROBLEM RESOLUTION

a. General management

Adequate nutritious food.

Regular exercise to reduce the weight.

Avoidance of fatty and oily food to reduce the weight.

b. Specific management

The case presented with prominent mental generals, physical generals and

characteristic particulars and so based on the totality, Natrum mur was selected in

moderate potency and administrated.

150

c. The aim of this action

The remedy also covers the dominant miasmatic state. Therefore no separate anti

miasmatic was considered. Moreover, as there was no acute state in the case, possibility

of acute remedy also ruled out.

Patient reported regularly for treatment and she showed significant improvement

and the ultrasonographic reports also revealed that the ovaries are normal.

Remedy Response:

Patient showed significant improvement both at mental and physical level.

Remedy Regulation:

Considering the high sensitivity, susceptibility, sector involved, constitutional

remedy is given infrequently. When susceptibility improved accordingly potency was

also raised.

Though there was considerable improvement with the constitutional treatment,

there happened a status quo in the progress of the cure in spite of raising the potency. For

this reason, Calcarea carb 1M was given as it follows the constitutional remedy well. For

this, reference was made from Boericke’s Materia Medica and other repertories. Patient

showed considerable improvement clinically thereafter and ultrasound showed no

abnormalities.

151

Education And Training:

This case gives concept of selection of constitutional remedy.

Efficacy of well selected medicine on all fronts, mental as well as physical could be

appreciated.

Role of detailed case taking to understand the patient as a person in chronic disease.

Importance of forming a chronic totality for the selection of similimum.

Importance of educating the patient about the continued medication in case of PCOS.

Importance of gaining the patient’s confidence in the management of the disease.

152

FR. MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL

STANDARDIZED PAPER IN HOMOEOPATHIC PRESCRIBING

PHYSICIAN: Dr. PK CASE NO. OPD: 53636/09 INDEX NO

ACTIONS REASONS

CLINICAL DIAGNOSIS Polycystic ovarian syndrome

Tension type headache

Allergic rhinitis

Irregular menses with

weight gain and with

ultrasonological

evidence.

Sensation of

heaviness & pressing

in the head with no

nausea or aura and no

tender sinuses.

Sneezing worse in the

morning with itching

in the throat and eyes.

153

PERCEIVING THE

TOTALITY

1. ACUTE

(a) Fixed general

totality.

Not considered.

(b) Sector totality.

2. CHRONIC.

(a) Dominant miasm.

Sycosis

Irregular menses, weight gain and

also on the pathology where there

is multiple cyst formation in the

ovaries.

(b) Acute exacerbation. Nil.

(c) Periodic expression. Nil.

(d) One sided

expression.

Nil

(e) Suppression. Nil.

(f) Mixed miasm. Nil.

(g) Sequence.

(h) Drug affects miasm.

(i) Cause

Fundamental

Precipitating.

Sycosis

--------

Maternal uncle – diabetic

154

(j) Aggravations. Consolation

Headache < morning and

stooping Sneezing <

morning

(k) Ameliorations. Headache better by sleep

(l) Generals.

Mental.

Physical

Anger when scolded

unnecessarily

Weeping when alone

Sensitive

Anger when day’s work

is not completed

Fastidious

Likes to be alone

Consolation <

Appearance – Stocky

Perspiration: Increased

Craving: Chocolates, Ice

cream, Salty food

Aversion – sweets

Thermal state – Hot

Attributes

155

Characteristic particulars

Irregular menses once in

40 – 45 days

Heaviness and Sensation

in the head as if pressed

<morning and evening

Sneezing < morning

Dandruff – Creamy

white.

III. REPERTORIAL

APPROACH.

1. Synthesis

2. Boeninghausen.

3. Kent.

4. Mixed.

5. Rubric.

Repertorisation using

synthesis repertory.

Presence of prominent mental and

physical generals and

characteristic particulars

Reading The Analysis.

Potential Differential

Field.

Hot patient

References to The

Homoeopathic Materia

medica.

Boericke’s materia

medica

Referred for selection of a

remedy which covers completely

after repertorial result

156

IV. NON

REPERTORIAL

APPROACH

1. Structuralisation.

Key Notes.

Mental generals:

Anger when scolded

unnecessarily

Weeping when alone

Sensitive

Anger when day’s work

is not completed

Fastidious

Likes to be alone

Consolation <

Physicals generals:

Appearance – Stocky

Perspiration: Increased

Craving: Chocolates, Ice

cream, Salty food

Aversion – sweets

Thermal state – Hot

Characteristic

particulars

Irregular menses once in

40 – 45 days

These are the characteristic

symptoms of the patient which

individualizes the case and points

the case towards the similimum.

157

Heaviness and Sensation

in the head as if pressed

<morning and evening

Sneezing < morning

Dandruff – Creamy

white.

V. PLANNING AND

PROGRAMING

THERAPY.

1. Acute RX.

Potency. Repetition.

2. Chronic RX.

Potency.

Repetition.

Natrum mur

200 – 10 M, 0/1

Infrequent

Chronic totality similimum.

Sensitivity is high but structural

changes present

3. Intercurrent RX.

Potency.

Repetition.

Constitutional remedy

covers this also

4. Placebo. S L Packets were given For satisfaction of the patient and

adequate spacing.

158

VI. REMEDY RESPONSE ACTION REASONS

a. Interpretation.

Good response as the

patient was better in both

general and sector level.

The patient has shown a

general improvement in all

levels suggesting that the

remedy was Similimum to

the case.

b. Action. The medicine was repeated

in increasing potency at

infrequent intervals.

Improvement in both

general and sector.

c. Purpose.

Reasoning.

Expectations.

To improve the complaints

of patient and get maximum

results.

There should be gradual

betterment of the patient.

Since the remedy was

Similimum to the case.

159

VII. GENERAL

COMMENTS

Though there was considerable improvement with the

constitutional treatment, there happened a status quo in the

progress in spite of raising the potency. For this reason,

Calc carb 1M was given as it follows the constitutional

remedy well (though it was ruled out in the beginning).

Patient showed considerable improvement clinically

thereafter and ultrasound showed no abnormalities. This

shows the efficacy of constitutional remedy as well as the

need and efficacy of a follow well remedy.

160

ANNEXURE 3: MASTER CHART

Sl. N

o.

Prel

imin

ary

Dat

a

Chi

ef

Com

plai

nt

Tota

lity

of

sym

ptom

s

Mia

sm

Rem

edy

regu

latio

n

Rem

edie

s gi

ven

duri

ng

follo

w u

p Score

Rem

arks

B A

1 Name: Mrs.L Age: 21 yrs Sex: F Religion: Hindu Occupation: Student Marital status: Single Residence: Sakthi nagar SCR No: 53636/09

Irregular menses once in 40 – 45 days since 1 yr Profuse flow. Clots – slight. Increase in weight more than 6 kgs. Moderate lower abdominal pain

Anger when scolded unnecessarily Weeping when alone. Sensitive Anger when day’s work is not completed Fastidious. Likes to be alone Consolation < Appearance – Stocky Perspiration – Increased Craving – Chocolates, Ice cream, Salty food Aversion – sweets Thermal state – Hot Irregular menses once in 40 – 45 days. Heaviness of head Sensation as if pressed < morning and evening Sneezing < morning Itching of eyes and throat irritation Dandruff – Creamy white

Sycosis Natrum mur 200

Nat. mur 1M

Nat mur 10M

Nat. mur

0/1

Calc carb 1M

9 2 Improved

161

2 Name: Ms.SK Age: 19yrs Sex: F Religion: Muslim Occupation: Beedirolling Marital status: Single Residence: Malar pavu SCR No: 13626/09

Irregular menses once in 3 months with profuse flow and black clots. since 1 yr

Consolation <2. Gets angry fast2. Weeps easily; fastidious Wants to be left alone only when gets sad Thirst: increased Cr: chicken, warm food, eggs3, sweets2, fish2. Bowel – hard. Chilly patient Irregular menses with headache and weakness

Psora Nat.mur 200

Sulphur 200 Calc 200 Lyco 200

9 1 Improved

3 Name: Ms.M Age: 22yrs Sex: F Religion: Muslim Occupation: Beedirolling Marital status: Single Residence: Bentwal SCR No: 19806/10

Amenorrhoea since 8 months Increase in weight more than 12 kgs Mild hair growth on the upper lip Flow – moderate No clots/ dysmenorrhoea

Shyness2

Dull2 Mild and gentle Company likes Consolation amel Cr: spicy2

Thirst: less but prefers cold water Thermal: Hot patient Amenorrhoea Increased hair growth Stocky

Sycosis Puls 1M Puls 10M

Thuja 200 7 5 Improved

162

4 Name: Ms. M Age: 21yrs Sex: F Religion: Hindu Occupation: Student Marital status: Single Residence: Kavoor SCR No: 54727/09

Acne – papular eruptions on forehead and face. No itching or pain. Irregular menses once in 40 – 45 days. Flow normal. No clots or no dysmenorrhoea

Mild Timidity2

Likes company Anxiety about future Cr: spicy2 Av: tea2, coffee2 Thermal: chilly Popular eruption on forehead Irregular menses White spots on nails

Sycosis Sil 30 Sil 200 Sil 1M

------ 5 1 Improved

5 Name: Ms. MP Age: 19 yrs Sex: F Religion: Hindu Occupation: Student Marital status: Single Residence: Sakthi nagar SCR No: 55622/10

Pimples – pustular and painful since 2 – 3 yrs. Itching < oily food Irregular menses once in 42 – 45 days since 2 - 3 yrs. Flow normal. Clots – more

Extrovert2 Friendly nature More attached to friends Easily adaptable Cr: ice cream2, chicken Thermal: Chilly Irregular menses Acne< oily food Burning per rectum during stool

Psoro Sycotic

Phos 200 Phos 1M

------ 12 2 Improved

163

6 Name: Ms L Age: 15yrs Sex: F Religion: Hindu Occupation: Student Marital status: Single Residence: Attavar SCR No: 55092/09

Irregular menses once in 4 months since 1 yr Profuse flow. No clots and pain Mild hair growth is there on the upper lip

Reserved Consolation agg Irritable Contradiction agg Cr: fried food2

Thermal: Hot patient Irregular menses with fainting Profuse bright red flow

Psoro Sycosis

Nat mur 200 Nat mur 1M

------- 7 1 Improved

7 Name: Ms R Age: 19yrs Sex: F Religion: Hindu Occupation: Student Marital status: Single Residence: Mangalore SCR No: 52814/09

Irregular menses once in 2 months since 3 yrs Scanty flow with clots and severe abdominal pain Increase in weight 15 – 20 kgs in two years

Consolation agg Fear of snakes Emotions suppressed Better after weeping Diminished appetite Av: milk2

Thermal: Chilly patient Irregular menses

Sycosis Sepia 200 ----- 11 2 Improved

164

8 Name: Ms. R Age: 15yrs Sex: F Religion: Hindu Occupation: Student Marital status: Single Residence: Mangalore SCR No: 55205/10

Acne - pustular and painful on face and forehead since 1 yr < after menses Irregular menses once in 40 – 45 days. Scanty flow. No clots, no hirsutism or no weight gain

Reserved2

Desires to be alone Contradiction agg

Irritable2

Anger – shouts back Consolation agg Cr: salt2, milk Thermal: hot patient Acne on face < perspiration and menses Itching < after bathing Irregular menses

Psoro Sycotic

Nat mur 200 Nat mur 1M

------- 7 1 Improved

9 Name: Mrs.P Age: 30yrs Sex: F Religion: Hindu Occupation: Lecturer Marital status: Married Residence: Jeppu SCR No: 54416/09

Irregular menses once in 45 – 50 days since 2 yrs Flow normal. Clots – mild Mild pimples (acne) on face

Complaints started after disappointed love and disappointment in career. Reserved2 Fastidious2

Sleeps – on abdomen Thermal: Hot Headache < sun Irregular menses

Psoro Sycotic

Nat mur 200 Nat mur 1M

------- 12 2 Improved

165

10 Name: Mrs PS Age: 29yrs Sex: F Religion: Hindu Occupation: Housewife Marital status: Married Residence: Karkala SCR No: 54262/09

Amenorrhoea since 10 months with mild abdominal pain and scanty flow. No clots

Indifferent2 towards family members especially husband. Introvert Reserved. Perspiration: increased on face and chest Dreams of snakes Thermal: Chilly patient Amenorrhoea

Sycosis Sepia 200

Mag.mur 200 Mag mur 1M

6 6 Dropped out

11 Name: Ms.P Age: 22 yrs Sex: F Religion: Hindu Occupation: Teacher Marital status: Single Residence: Bantwal SCR No: 15841/09

Increased hair growth on upper lip and chin since 4-5 yrs Acne on face with pain and pus discharge Irregular menses once in 40 days since 3-4 yrs with abdominal pain

Anxiety3 with new responsibilities. Self doubt3 regarding her abilities. Better by consolation. Pessimistic Cr: oily food2, Meat3 Av: vegetables Thermal: Ambithermal to Hot Increased facial hair growth. Delayed menses Pimples < oily food < before menses > once flow starts

Psoro-Sycotic

Lyco 200 Lyco 1M Lyco 10M

Thuja 1m 13 4 Improved

166

12 Name: Mrs.AB Age: 22 yrs Sex: F Religion: Muslim Occupation: Tailor Marital status: Single Residence: Deralakatte SCR No: 13471/09

Irregular menses once in 2 months since 9 yrs (since menarchy) Scanty flow with abdominal pain, back pain and clots

Desires to be alone3 Consolation agg Reserved Thermal: hot patient Irregular scanty menses with back pain and abdominal pain

Sycosis Nat.mur 200

----- 8 2 Improved

13 Name: Ms.S Age: 21 yrs Sex: F Religion: Hindu Occupation: Student Marital status: Single Residence: Mangalore SCR No: 17821/10

Increased hair growth on face, chin and neck since 2 yrs. Irregular menses once in 45 days with profuse flow and clots. Mild abdominal pain during menses.

Jovial2. Extrovert Helpful. Sympathetic2 Perspiration especially on neck and face. Cr: spicy, fried food. Av: sweet Chilly patient Hair growth on chin and neck Irregular menses

Psoro – Sycotic

Phos 1M ------- 10 2 Improved

167

14 Name: Ms.CC Age: 21yrs Sex: F Religion: Hindu Occupation: Student Marital status: Single Residence: Kerala SCR No: 55951/10

Irregular menses once in 2 months

Changeable2 Slow and sluggish in all actions Mild and yielding2 Company – likes2 Consolation – likes Thirst – less Leucorrhoea before menses Cr: ice cream Thermal: hot patient Irregular menses Diarrhoea before menses

Sycosis Thuja 200

Puls 30 6 2 Improved

15 Name: Ms.SS Age: 21 yrs Sex: F Religion: Hindu Occupation: Student Marital status: Single Residence: Mangalore SCR No: 51262/09

Irregular menses once in 45 – 48 days since 6 – 7 months. Increase in weight more than 5 – 6 kgs

Sympathetic Likes company3

Changeable in decision Consolation amel. Anxiety about health Cr: spicy2, fruits Av: milk Thermal: Hot pt Irregular menses with increase in weight

Sycotic Lyco 30 ----- 5 1 Improved

168

16 Name: Ms.SA Age: 19 yrs Sex: F Religion: Muslim Occupation: Student Marital status: Single Residence: Ullal SCR No: 17622/10

Irregular menses once in 3 months since 2 yrs. Profuse flow with clots. Dark bleeding. Slight lower abdominal pain Acne -itching, painful < during menses Hair fall, dandruff

Weeps easily2. Mild2 and shy Likes company. Likes consolation Timid. Stage fear. Changeable mood. Cr: chicken, ice cream, spicy food2 Thermal: hot patient Menses irregular Profuse dark red flow with clots Dysmenorrhoea Pimples itching and painful < before menses.

Psoro – Sycotic

Puls 1M Silicea 1m 12 3 Improved

17 Name: Mrs.SV Age: 30yrs Sex: F Religion: Christian Occupation: House wife Residence: Belthangady SCR No: 58863/10

Irregular menses once in 2 months since 1 yr. Infertility (married since 3½ yrs)

Weeps easily for silly things Gets angry soon and shouts back Irritable2. Wants to be alone2. Remorse3. Thirst – less Cr: spicy2, sweets Thermal: Hot Irregular menses Increased sexual desire before menses

Sycotic Nat.mur 1M

Thuja 1m 7 2 Improved

169

18 Name: Ms.A Age: 16 yrs Sex: F Religion: Hindu Occupation: Student Marital status: Single Residence: Kodikal SCR No: 60353/11

Irregular menses once in 2-3 months since 2 yrs. Profuse bright red flow

Likes to be alone Irritable. Sensitive. Weeps easily3. Fear of dark. Fear of strangers. Cr: chocolates, spicy items3. Av: Bitter Thermal: Hot patient Irregular menses Delayed menses

Psoro – Sycotic

Puls 200 Sulphur 1M

9 1 Improved

19 Name: Mrs.ZR Age: 28yrs Sex: F Religion: Muslim Occupation: House wife Marital status: Married Residence: Maddu SCR No: 21076/11

Irregular menses once in 3 months since 2 yrs. Spotting, clots present Increased hair growth on upper lip severe Mild abdominal pain during menses

Dependant. Suppressed emotions2 Thirst increased Cr: fish3 Bowels: habitual constipation Menses: irregular, scanty, protracted Perspiration: increased on upper lip Thermal: hot patient

Psoro – Sycotic

Nat mur 200

Kali carb 200

10 7 Not improved

170

20

Name: Mrs.DP Age: 22yrs Sex: F Religion: Christian Occupation: House wife Marital status: Married Residence: Ranipura SCR No: 18038/10

Irregular menses once in 3 months since 2 yrs Scanty flow with clots and moderate abdominal pain during the menses

Brooding 2 Weeps when alone Cr: spicy3

Av: sweets2

Thermal: Hot patient Irregular menses Menses scanty Mapped tongue

Sycosis Nat. mur 200 Nat mur 1M

------ 8 1 Improved

21 Name: Mrs.M Age: 25 yrs Sex: F Religion: Muslim Occupation: Beedirolling Marital status: Married Residence: Konaje SCR No: 16449/10

Irregular menses once in 2 months since puberty (12 yrs of age). Profuse bleeding. Weight gain – 13 kgs in 1 yr Mild facial hair growth Primary infertility (married since 10 yrs)

Mild Company likes Consolation amel2

Weeping while narrating the complaints Fear of thunderstorm Appetite - decreased Thirst - ½ lts /day Cr: Spicy2, sweets Av: sour Thermal: chilly Irregular menses with hirsutism.

Sycosis Puls 200 Puls 1M

---------- 11 2 Improved

171

22 Name: Ms.SZ Age: 18 yrs Sex: F Religion: Muslim Occupation: Beedirolling Marital status: Single Residence: Mangalore SCR No: 14347/09

Acne on face, chest and back with itching. Pustular eruption Increased hair growth on face. Irregular menses once in 4-6 months with clots and scanty flow since 4 yrs

Ambitious Likes to be in company3

Fear of opposite sex2

Does not like contradiction Perspiration: increased on chest, back of neck. Cr: chicken2, icecream3, spicy3, salt3 Thermal: Hot Irregular menses with scanty flow and clots Acne – pustular eruption with itching < summer season

Psoro-Sycotic

Puls 1M Sulphur 1M Apis 30

10 8 Not Improved

23 Name: Ms.PD Age: 21yrs Sex: F Religion: Christian Occupation: Office assist. Marital status: Single Residence: Nithyangar Nagar SCR No: 18760/10

Irregular menses once in 2 months since 1 yr Burning pain in the stomach since 3 months. Frontal headache since 3-4 months

Reserved, fear of strangers. Anticipatory anxiety3 Perspiration: more on face Cr: chicken2, spicy2, salty food, sweets2 Chilly patient Irregular menses with abdominal pain and clots. Burning in abdomen < morning > after eating. Easy satiety. Frontal headache< empty stomach

Psora - Sycotic

Lyco 200

Thuja 1M Apis 30

9 3 Improved

172

24 Name: Ms.MD Age: 19 yrs Sex: F Religion: Christian Occupation: Student Marital status: Single Residence: Udupi SCR No: 56757/10

Irregular menses once in 40 days Profuse bleeding with clots

Likes company. Mild2 Dependant Indecisive2. Likes consolation. Anxiety and fear about exams. Cr: sweets Thermal: Hot Irregular menses once in 40 days. Profuse bleeding with clots Stains difficult to wash.

Psoro – Sycotic

Puls 200 Puls 1M

Thuja 200 9 2 Improved

25 Name: Ms.JM Age: 21yrs Sex: F Religion: Christian Occupation: Student Marital status: Single Residence: Mangalore SCR No: 57637/10

Irregular menses once in 20 days since 3 yrs with back pain and clots.

Irritable3. Gets angry soon Wants to be alone Consolation amelioration Indecisive Cr: sweets3 Thermal – hot patient Irregular menses once in 20 days profuse flow with clots. Back pain and abdominal pain

Sycosis Nat mur 200

Puls 200 9 1 Improved

173

26 Name: Ms.MJ Age: 21 yrs Sex: F Religion: Christian Occupation: Student Marital status: Single Residence: Kerala SCR No: 57307/10

Irregular menses once in 2 months since 5yrs. Menses profuse with clots Pain in back and abdomen during menses. Increased hair growth on upper lip and chin

Anxiety during exams3. Anger easily. Shouts back. Likes company2. Perspiration increased on axilla and face. Thermal – hot patient Stool – 2 to 3 times during menses Irregular menses with profuse flow. Clots+. Hirsutism and abdominal distension

Sycotic Lyco 200 Lyco 1M

Medo 200 10 1 Improved

27 Name: Ms.P Age: 16yrs Sex: F Religion: Hindu Occupation: Student Marital status: Single Residence: Orvathur SCR No: 54059/09

Irregular menses once in 40 days since 3 yrs Profuse menses with clots and dysmenorrhoea.

Loquacious3. Startles easily at noise. Cr- sweets Av- bread Hot patient Irregular menses Diarrhoea before menses

Sycotic Lachesis 30 Lachesis 0/1

Sulph 0/1 8 3 Improved

174

28 Name: Mrs.BS Age: 26 yrs Sex: F Religion: Hindu Occupation: House wife Marital status: Married Residence: Jeppu SCR No: 56931/10

Irregular menses once in 40 – 45 days since 2 yrs Weight gain, increased hair growth on upper lip and face. Severe lower abdominal pain and back pain

Irritable2

Anger for silly things Short tempered A/F grief due to sudden death of her child. Weepy. Likes company2

Consolation – amel; likes Guilt feeling. Sudden mood change. Dreams: anxious; misfortune of Thirst – less Cr: spicy2 and sweets. Thermal: hot patient Irregular menses with weight gain and blackish red menses.

Sycosis Graph 200

Puls 1M Med 1M

10 3 Improved

29 Name: Mrs.ZB Age: 23 yrs Sex: F Religion: Muslim Occupation: House wife Marital status: Married Residence: Ullal SCR No: 21817/11

Irregular menses once in 2 months. Profuse flow with clots and severe lower abdominal pain during menses. Acne

Insecurity feeling. Affectionate uncontrollable laughing. Weeps when alone. Consolation agg Brooding Cr: spicy2. Perspiration increased all over the body. Irregular menses with dysmenorrhoea and acne. Headache < sun

Sycosis Ignatia 1M

Nat.mur 200

11 11 Dropped out

175

30 Name: Ms.SV Age: 18yrs Sex: F Religion: Hindu Occupation: Student Marital status: Single Residence: Kavoor SCR No: 54513/09

Amenorrhoea since puberty FMP: 6/6/09

Slow and sluggish3 Anxious during exams Fear of sounds Appetite: decreased Cr: chocolates2, fried food2, salt, potatoes Thermal – ambithermal Amenorrhoea

Psoro – Sycotic

Calc carb 1M

Lyco 1M Sulph 1M Puls 10M Thuja 1M

4 4 Not improved