Abstract:

Obstructive jaundice  can be  treated  with homoeopathic medicines. Present day scientific society wants evidenced based treatment, a case unsuccessfully treated in a nursing home was treated with Nux vomica  successfully.  It was an evidenced based treatment with investigations. 

Introduction :

Obstructive jaundice is defined as 'surgical" jaundice  i.e. obstruction at the major intrahepatic or extrahepatic duct level. Obstructive jaundice  may be intrinsic (mass, stricture, stone) or extrinsic (mass, inflammation), and its levels include intrahepatic, suprapancreatic and intrapancreatic.(2)

Gallstone disease is a complex disorder where both environmental and genetic factors contribute towards susceptibility to the disease. Epidemiological and family studies suggest a strong genetic component in the causation of this disease.Gallstone disease in the population is complex because it involves the interaction of multiple genes with varied environmental factors.(6)

Gallstones affect about 10% of adults over 40. They occur in nearly 6% in the adult population of North India ,25% of women in the U.S. by age 60 and in up to 50% by age 75. About 20% of men have gallstones by the time they reach 75 years of age. Because most cases are asymptomatic, however, these rates may underestimate the disease in elderly men. Gallstone disease is relatively rare in children.

Women are probably at increased risk because the female hormone estrogen stimulates the liver to remove more cholesterol from blood and divert it into the bile. Female ratio is 1.9:1. very low calorie diets and Obese individuals are more likely to form gallstones than thin individuals. Pregnancy increases the risk for cholesterol gallstones because during pregnancy, bile contains more cholesterol. Individuals with Crohn's disease. Gallstones occur more frequently in individuals with elevated blood triglyceride levels  (3,6).

Common causes of Obstructive jaundice are Neoplasm's of the pancreas, liver, and bile duct. The others are cholelithiasis , hepatoma rarer causes of Obstructive jaundice include parasites such as worms, scarring from previous surgical procedures, bile duct inflammations and congenital malformations of the bile duct system (1,5).  

Charcot's triad of intermittent fever, pain in right upper quadrant , jaundice  is characteristic of ascending cholangitis and indicates biliary obstruction, Nausea or vomiting preceding  Jaundice, stone dark urine, pale feces, and itching are other symptoms. Mild elevation of SGPT levels, An elevated alkaline phosphatase (above 30 K.A. units) is ,always present in obstructive  jaundice. (5)

Diagnosis is based on elevated Alkaline phosphatase (twice the normal value more ,30 K.A. units), SGPT and total serum bilirubin. Ultrasonography is the initial diagnostic procedure. A  percutaneous transhepatic choleangiogram or ERCP is a option to localize and characterize the obstruction. If a distal common bile duct obstruction is noted, a CT scan is recommended to image the head of the pancreas.

When  obstruction of the bile-carrying duct is prolonged (more than 6 hours), then distention and inflammation can develop with secondary bacterial infection in about 50% of cases. This is a serious complication that usually requires immediate medical attention .

In treating such patients, the homoeopathist has to consider the whole constitution of the patient in order to clear the gallstones. To find the drug most suitable for the patient, we have to keep in mind not the diagnosis but the symptoms of the patient are of the greater importance. (2),  H.C. Allen, who made the statement he quoted. It is a case well taken is a long way to a cure. The dominant miasm for Cholelithiasis is Sycosis on the basis of Pathology, Pressure and pain in the lower region of liver and hypochondrium favor the Psoric miasm (4)

ILLUSTRATIVE CASE:

Patient aged 15 years visited my clinic on 03-08-2001, came with following complaints

PRESENTING COMPLAINTS:

• Fever with chills since 30days, itching all over the body,
• Thirst. ++++, difficult to swallow, bowels: constipated and offensive smell pale in colour, urine: yellow, appetite: decreased. Desires: spicy food or snakes.

H/o PRESENTING COMPLAINTS:

PAST HISTORY: Nothing Specific

FAMILY HISTORY:

• Father: Healthy
• Mother: apparently healthy
• Siblings:  apparently healthy.
•  H/o HTN, DM, in the family.

PERSONAL HISTORY:

• Appetite: wanting,
• Thirst:  increased
• Desires: spicy
• Aversions: - np
• B/M: constipated, offensive, pale colour,
• Urine: D/N - 7/1, no burning
• Sleep: NR
• Thermal Reaction: chilly
• GENERAL PHYSICAL EXAMINATION:
• Weight: 41Kgs
• Pt is moderately built , O/E: throat not congested,
• Icterus - present

SYSTEMIC EXAMINATION:

• CVS:   NAD
• RESP: NAD
• CNS: NAD
• GIT: Mild tenderness in the liver region -slight enlargement of the liver,  Murphy's sign positive.   

PROVISIONAL DIAGNOSIS: obstructive  jaundice

INVESTIGATIONS OF SIGNIFICANCE:

Before start of treatment:

31/07: Serum Bilirubin: 7 mg%

31-07-2001: U S Scan was done, impression was

   1) Mildly altered endogenicity of Liver parenchyma.

   2) Gall bladder lumen septate with calculi measuring 6mm.

                 02-08-2001:

   Serum Bilirubin: 5.6 mg%

                      DIRECT: 3.9 mg%

   Albumin:  Globulin Ratio: 1.2: 1

   S G O T: 129 IU

   S G P T:  14.3

   Alkaline Phosphatase: 230 IU

                      Reticulocyte count: 2.0%

   TWBC: was 10400 /cu mm

CLINICAL DIAGNOSIS: obstructive  jaundice

CLINICAL CLASSIFICATION: Dynamic chronic fully developed miasmatic disease

MIASMATIC DIAGNOSIS: Psora- sycotic and syphilis

TOTALITY OF SYMPTOMS/

REPERTORIAL TOTALITY:

• Fever thirst
• Itching whole body
• Constipated
• Desire spicy food
• Offensive stool
• Colic pain from jaundice
• Jaundice

REPERTORIAL RESULT:

Nux.vom - 18/7, Ars - 16/6, China 12/6, Hepar sulf 9/6.

ANALYSIS OF REPERTORIAL RESULT

Nux.vom covered more marks and score.

SUSCEPTIBILITY: High

TREATMENT AND FOLLOW UP:

First prescription: 30-08-2001

NUX VOM 30,5D, Natrum sulf 6x 4tabs 12^th hourly, china q 8 drops 12^th hourly in water for a 10days were Given

Comment: As Alkaline Phosphatase: 230 IU was high indicate Biliary Tract obstruction (If it raises more than 2 times the normal value). As patient was shifted from a nursing home and on the bases of the condition of the patient I gave above medicines.

Patient reported on 17-09-2001 with liver function report as shown below : fever reduced , weakness, itching slight, pain in right and left hypochondria, Serum Bilirubin: 5.6 mg% to 1.1 mg% , Alkaline Phosphatase: reduced from 230 IU to 135IU,

On examination abdomen was movable but little tender, as he was complain pain in right and left hypochondria ,he was advised to under go US Scan of whole abdomen.

Mag phos 30,5doses , Nat sulfa 6x 4tabs 12^th hourly for 2days followed by NUX VOM 30,5doses and  Nat sulfa 6x for 7days were given. And waited for US Scan report.

L F T Report : 05/09/2001

Serum Bilirubin: 1.1 mg%

Bilirubin Direct: 0.4 mg%

Total Proteins: 7

SGOT: 145 IU

SGPT 180 IU

Alkaline Phosphatase :135 IU/L

29-10-2001:  patient reported on 29-10-2001:  with occasional  pain in upper abdomen (right hypochondria)  Bowel movement was normal, regular. Urine colour was white in colour, slight weakness. Serum Bilirubin : reduced from 1.1mg to 0.7 mg and Serum alkaline phosphatase : from 135 IU/L to 11.0 KA Units.

Rubrum 15 days, was given ,

15-11-2001

Patients general condition improved, with good appetite, normal bowel movement.

Sulphur  30,3D, were given Rubrum 15days were given.

Summary : There is a misconception that homoeopathy may not work in serious complication that usually requires immediate Surgical or medical attention. The above illustrated case is an example how homoeopathy does wonders.

References :

• Nadkarni KM, Jahagirdar RR, Kagzi RS, Pinto AC, Bhalerao RA, Surgical Obstructive jaundice Volume : 27 , Issue : 1 , Year : 1981 ,
• www.jpgmonline.com/article.asp?issn
• Ellis Barker J, Gallstones, Heal Thyself (The Homoeopathic World), Volume: 1940 Feb Vol LXXV No 890.
• http://www.wrongdiagnosis.com/g/gallstones/stats.htm
• H.A.Roberts, The Principles and Art of cure by Homoeopathy, reprint edition 2005, B. Jain Publishers Private Limited, Page 234, 241.
• D Lawal, S Oluwole, Diagnosis, management and prognosis of obstructive jaundice in Ile-Ife, Nigeria. West Afr J Med. ;17 (4):255-60 9921092 (P,S,E,B)