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Homoeopathic management of essential hypertension: A narrative review
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Received: ,
Accepted: ,
How to cite this article: Sonny R. Homoeopathic management of essential hypertension: A narrative review. J Intgr Stand Homoeopathy. 2023;6:108-14. doi: 10.25259/JISH_24_2023
Abstract
Objectives:
Hypertension (HTN) or elevated blood pressure is a serious medical condition that significantly increases the risk of heart, brain, kidney, and other diseases. HTN in an adult is said to be present when clinical systolic and diastolic blood pressure exceed 140 mm and 90 mm of hg, respectively. An estimated 1.28 billion people aged 30–79 years have HTN worldwide, most (two-thirds) living in low- and middle-income countries (World Health Organization). Homoeopathy can be useful in managing HTN and its complications, for which a proper knowledge of treatment modalities available in homoeopathy is essential.
Materials and Methods:
An intensive search of articles, publications, and writings, both online and offline, dealing with the management of essential HTN through homoeopathy was conducted between November 2021 to January 2022. Databases such as Google Scholar, PubMed, ScienceDirect, and various other published books, literature, and anecdotes in homoeopathy were explored, collecting data on the role of homoeopathy in essential HTN. Emphasis was on words such as homoeopathy, HTN, and blood pressure.
Results:
Management of essential HTN through homoeopathy can be broadly divided into two categories. First, drugs or medicines given in homoeopathic literature, such as Materia Medicas and Repertories, whose choice of administration in HTN depends on the classical methods of prescription, and secondly, drugs or medicines obtained from research outcomes on HTN.
Conclusion:
In homoeopathic therapeutics, many medicines are available and used in cases of essential HTN. Recently, research activities targeted toward managing HTN through homoeopathy have increased, and data have been generated. Even then, the available data till now are not sufficient in bringing homoeopathy equivalent or near to the conventional system of medicine in managing HTN demands; in turn, more research works in homoeopathy with statistical rigour.
Keywords
Homoeopathy
Essential hypertension
Materia Medica
Repertory
INTRODUCTION
Hypertension (HTN), defined as persistently high blood pressure, is a major risk for the development of cardiovascular disease. It is said to be present when the clinical systolic pressure exceeds 140 mmHg and/or diastolic pressure exceeds 90 mmHg[1]. Patients with HTN have a two-fold incidence of coronary heart disease, a four-fold incidence of congestive heart failure, and a seven-fold incidence of stroke compared to those with normal blood pressure. At present, an estimated 1.28 billion people aged 30–79 years have HTN worldwide, most (two-thirds) living in low- and middle-income countries.[2] In 95% of cases, a definable cause of HTN cannot be found; such cases are termed primary, essential, or idiopathic HTN. If HTN is a consequence of a specific disease or abnormality, it is termed secondary HTN. The causative factors include strong familial and genetic predisposition, along with environmental factors, weight gain, salt intake, alcohol intake, and smoking.[3] The usual symptoms are headaches (particularly at the back of the head and in the morning), light-headedness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision, and fainting episodes.
In a study by Kretchy et al., it was found that complementary and alternative medicine (CAM) is very popular in the treatment of HTN.[4] Hu et al. reported a high prevalence of CAM use among HTN patients.[5] In India, where medical pluralism is quite prevalent, various treatment methods are available for managing HTN with varying success.
MATERIALS AND METHODS
Online and offline literature related to the management of HTN through homoeopathy was searched. Various databases, including Google Scholar, PubMed, and Science Direct, were explored. Emphasis was laid on ‘words like’ homoeopathy, HTN, and blood pressure. Available articles, books, literature, and anecdotes in homoeopathy published till January 2022 were searched for data on this topic.
Findings
A total of 29 articles on the management of HTN through homoeopathy were found. A few articles were not accessible, and a few were not in English. According to the collected documents and information, the management of essential HTN using homoeopathy can be summarised in two groups: (a) The classical way of treating essential HTN and (b) treatment based on research outcome.
The classical way of treating essential HTN
These are the processes that have been mentioned in homoeopathic literature added by different stalwarts from time to time. The following are examples of major ways of getting a choice of medicine in the case of essential HTN.
Prescription using the totality of symptoms
Keynote prescribing
Pathological prescribing.
Prescription using the totality of symptoms
Here, the remedy is selected based on matching the patient’s totality of symptoms with the symptoms of the medicine. While drawing the totality of symptoms, one must consider the weightage of other factors such as miasm, constitution, accessory circumstances, and probable cause if they are found prominent.[6] A case of essential HTN may be psoric, psychotic, or syphilitic, whose indicating symptoms may be found in the literature on miasms.[7] Until the chronic miasms are put in a latent state, chronic diseases like essential HTN are not cured. After chalking out the totality of symptoms, referring to repertories and Materia Medica is important for selecting the correct remedy. A few important repertories having rubrics related to essential HTN are given in [Table 1].[8-10]
| S. No | Repertory | Rubric |
|---|---|---|
| 1. | The essential synthesis repertory, edited by Schroyens.[8] | Generals-HTN |
| 2. | Repertory of the Homoeopathic Materia Medica by Kent.[9] | Generals-pulse-hard |
| 3. | Homoeopathic medical repertory by Murphy.[10] | Blood-HTN, high blood pressure |
HTN: Hypertension
Keynote prescribing
Keynotes are the important, characteristic symptoms of medicine that have been clinically proven. When medicine is selected based on these symptoms, it is called keynote prescribing.[11] Some medicines having keynote symptoms in the domain of blood pressure[12] are given in [Table 2].
| Medicine | Symptoms/indication |
|---|---|
| Adonis vernalis | A heart medicine after rheumatism or influenza, Bright's disease, or kidney affections. Where the muscles of the heart are in a stage of fatty degeneration, which regulates the pulse and increases the power of contractions of the heart, with increased urinary secretion. Most valuable in cardiac dropsy. Low vitality with a weak heart. |
| Allium sativum | This is a medicine for high blood pressure with high cholesterol levels. This medicine helps in reducing cholesterol levels as well as lowering blood pressure. Other symptoms include pain in the chest that prevents sleep and leads to palpitations. It has vasodilatory properties. |
| Amylenum nitrosum | Palpitations ofthe heart and similar conditions are readily cured by it. Precordial anxiety. Tumultuous action ofheart pain and constriction around the heart. Headache and flushes ofheat, with anxiety and palpitation, are the keynotes for prescribing. |
| Aurum metallicum | Mental depression, suicidal tendencies, and cardiac symptoms are indicative of this drug—high blood pressure. |
| Aurum sodium | HTN with arteriosclerosis and senile paresis are useful indications. |
| Baryta carbonicum | Drug for old age. HTN, senility, and senile behavioural changes are good indications. |
| Baryta muriaticum | HTN, where the systolic pressure is high and diastolic pressure is too low. |
| Cactus grandiflorus | HTN with cardiac involvement. The typical angina pain and constriction feelings are indicative. |
| Conium maculatum | HTN of old bachelors and old maids. Arteriosclerosis. |
| Crataegus oxyacanthus | Said to have a solvent power on crustaceous and calcareous deposits in arteries. HTN with cardiac symptoms such as palpitation on slight exertion and dyspnoea. Insomnia. |
| Glonoine | HTN with congestion in the brain causes severe headaches. Climacteric HTN with congestion in the head. Headache having a haircut. Threatened apoplexy. |
| Kalium iodatum | HTN with syphilitic origin. The typical lancinating pain in the head and bone pains, along with HTN, are indicative. |
| Kalmia latifolia | Fluttering of heart with weak, slow pulse and anxiety. Palpitations were worse leaning forward. Gouty and rheumatic metastasis of the heart. Tachycardia, with pain (angina pectoris). Heart's action tumultuous, rapid, and visible. |
| Lycopodium clavatum | HTN with gastric irritation and flatulence. Craving for sweets and warm food and time modality are indicative. |
| Natrum muriaticum | It is a great drug for many constitutional diseases such as hyperthyroidism, goitre, Addison’s disease, diabetes, and HTN therefrom. The headache, craving for salt, mental irritability, and emaciation are indicative. |
| Natrum iodatum | Syphilitic cases (tertiary syphilis), angina pectoris, vertigo, dyspnoea, and endocarditis. |
| Phosphorus | Tall, intelligent, hypertensive people with cravings for ice-cold things. Warm food is rejected by the stomach. Haemorrhages in hypertensive patients where blood does not easily coagulate a lack of fibrin. |
| Strontium carbonicum | High blood pressure with a flushed face. Pulsating arteries threatened apoplexy. Complaints > immersing in hot water <cold. |
| Spartium scoparium | Its effect caused a lowering of systolic and diastolic blood pressure in provers. So used as palliative in physiological doses to combat arterial HTNs. |
| Vanadium | A good remedy for degenerative conditions of the liver and arteries. HTN with symptoms of gastrointestinal irritation such as anorexia, nausea, and vomiting. Arteriosclerosis feels fullness and compressed sensation in the heart, atheroma of arteries of the brain and liver. |
HTN: Hypertension
Pathological prescription
This type of prescription targets the disease pathology and is generally used in low potency or mother tincture form.[13] Medicines used in HTN are cited in [Table 3].
| Medicine | Symptoms/indication |
|---|---|
| Prunus virginiana Q | Whenever there is chamber hypertrophy or ventricular strain indicated in ECG. |
| Pituitrinum 200 | For cases of HTN with coronary artery disease. |
| Rauwolfia serpentina Q | Violent congestion, bursting throbbing headache, and haemorrhage from nose have proved clinically useful in HTN. |
| Amyl nitrosum Q | Acts as vasodilator. It relieves all conditions resulting from spasmodic constriction of blood vessels. |
| Allium Sativa Q | Causes thinning of blood and also works as a diuretic, thus lowering the BP. |
| Passiflora Q | Relieves nervous tension, acts as a relaxant, and relaxes the blood vessels. |
| Spartium scoparium Q | Acts as a diuretic, useful in case of renal HTN and HTN with oedema. |
| Pascidia Q | Works as a relaxant and is a powerful sedative. |
HTN: Hypertension, BP: Blood pressure, ECG: Electrocardiogram
Treatment based on research findings
Articles based on case reports, review articles, clinical observational studies, randomised controlled trials, studies on animal models and provide sufficient ground to believe that a good number of studies have been conducted exploring the role of homoeopathy in HTN. In some studies, a single medicine was used, whereas in others, multiple medicines have been tried. Individualised homoeopathic medicine and other drugs/medicines, such as Spartium scoparium, Viscum album, Lachesis muta, Baryta muriaticum, Rauwolfia serpentina, and Natrum muriaticum, were found effective in controlling HTN in different trials. Medicines showing positive effects prove that homoeopathic remedies have scope for managing HTN. The articles included in the study are described in [Table 4].[14-31]
| S. No. | Research publications/articles | Name of the authors | Year of publications | Outcome |
|---|---|---|---|---|
| 1. | Severe HTN was treated with Spartium and the constitutional homoeopathic remedy.[14] | Jack | 1979 | Case of HTN which resisted conventional treatment, improved by Spartium scoparium (broom) mother tincture. |
| 2. | Homoeopathy effect on high blood pressure.[15] | Ahmad | 2004 | A case of HTN was treated with L. muta. Symptoms such as pruritus, vertigo, depressed mood, anxiety, dyspnoea, sweating, and cough disappeared, and blood pressure did not increase for 15 months. |
| 3. | HTN and Homoeopathy.[16] | Singh | 2021 | Along with medicines such as Natrum muriaticum, Glonoinum, Crataegus oxyacantha, Baryta mur, Adonis vernalis, Allium sativum, Amylenum nitrosum, and Kalmia latifolia prescribed on the basis of similimum general management like diet control and physical exercise are needed for treatment of HTN. |
| 4. | HTN: Fundamentals and management.[17] | M Giri, R Goenka |
2015 | As per homoeopathic philosophy, any drug can be indicated depending on the totality of symptoms. Medicines such as Natrum muriaticum, R. serpentina, Convallaria majalis, Baryta muriatica, A. metallicum, Uranium nitricum and Lycopus Virginicus have been prescribed on the basis of personal work experience and research. |
| 5. | Individualised homoeopathy versus placebo in essential HTN: A double-blind randomised controlled trial.[18] | Koley et al. | 2013 | Individualised homoeopathy produced a significantly different hypotensive effect than placebo. Medicines such as Natrum muriaticum, Calcarea carbonica, Sulphur, T. occidentalis, Nitric acid, and Medorrhinum were indicated and administered. |
| 6. | R. serpentina (Aqua): A new approach in the treatment of HTN in Homoeopathy.[19] | Rastogi and Baig | 1996 | R. serpentina controlled the blood pressure and ameliorated the associated symptoms. |
| 7. | The effect of a homoeopathic drug on the blood pressure of hypertensive patients-a randomised double-blind controlled parallel group comparative trial.[20] | Hitzenberger et al. | 2005 | The effect of Pumpan on systolic and diastolic blood pressure does not differ from placebo. Pumpan is a drug product used for the improvement of cardiac activity and in chronic ischemic heart disease, arterial HTN, cardiac insufficiency, dystrophic myocardial changes, and vegetovascular dystonia |
| 8. | Controlled randomised, double-blind study for the comparison of the treatment of patients with essential HTN with homoeopathic and with pharmacologically effective drugs.[21] | Hitzenberger et al. | 1982 | The effects of anti-hypertensive pharmacotherapy were compared with those of homoeopathic treatment in ten patients with essential HTN and found that blood pressure lowering effect under pharmacotherapy is clearly superior to that under homoeopathic treatment, where it was negligible and statistically not significant. |
| 9. | Controlled double-blind trial with Baryta carbónica 15 CH versus placebo in a group of hypertensive subjects confined to bed in two old people's homes.[22] | Bignamini et al. | 1987 | No statistically significant differences were found between the effects of placebo and Baryta carbonica on the blood pressure. The four subjects who were sensitive reported strongly positive results. |
| 10. | Efficacy of individualised homoeopathic medicines in intervening the progression of pre-HTN to HTN: A double-blind, randomised, placebo-controlled trial.[23] | Dutta et al. | 2021 | After three months of intervention, the number of patients having progression from pre-HTN to HTN between groups was similar without any significant differences in between (all P>0.05). The trial was inconclusive. Individualised homoeopathy and drugs such as L. clavatum, T. occidentalis, and Natrum muriaticum were used. |
| 11. | Clinical evaluation of V album mother tincture as an anti-hypertensive: A pilot study.[24] | Poruthukaren et al. | 2014 | Using paired t-test, a significant drop in blood pressure (P<0.0001) and serum triglyceride (P<0.0001) was observed in the treatment group. This dual effect of V. album optimising therapy for primary HTN was found. |
| 12. | Study the effectiveness of L. muta 30C in patients with essential HTN in the age group of 20-75 Years.[25] | Sharma et al. | 2020 | Homoeopathic medicine L. muta 30C produced a significant effect in reduction of the blood pressure level in essential hypertensive patients. |
| 13. | A non-randomised single-arm prospective clinical study to see the effect of Natrum muriaticum 30C in the patients of essential HTN.[26] | Pati et al. | 2021 | Homoeopathic medicine Natrium muriaticum 30C produced a significant effect in reduction of the blood pressure level in essential hypertensive patients. |
| 14. | The hypotensive effect of homoeopathic medicines. In the management of the patients suffering from uncomplicated essential HTN -A Prospective, Observational Study.[27] |
Daryani and Pattanaik | 2016 | Individualised homoeopathic medicines produced a significant hypotensive effect compared to placebo. Individualised homoeopathy and drugs such as Natrum muriaticum, Lachesis, Glonoine, Gelsemium, Bryonia alba, A. metallicum, Pulsatilla, Sulphur, Digitalis, and Belladonna were used. |
| 15. | A retrospective cohort study on the efficacy of homoeopathy compared to homoeopathy plus conventional medicine in the treatment of HTN.[28] | Phing | 2016 | While the demand for T/CAM is on the rise, more evidence is needed to evaluate whether the clinical use of homoeopathy will bring any beneficial effects to the community at large. |
| 16. | The usefulness of homoeopathy in essential HTN: an exploratory interventional trial.[29] | Mehra | 2015 | The results showed that constitutional treatment based on homoeopathic principles might represent a satisfactory option for the management of essential HTN. Drugs such as Arsenicum album, Natrum muriaticum, Nux vomica, Causticum, and L. clavatum were found effective. |
| 17. | Homoeopathic medicine R. serpentina ameliorate blood pressure and oxidative stress parameters of kidney by modulating the expression of antioxidant enzymes in a deoxycorticosterone acetate-salt-induced hypertensive rat model.[30] | Kumar et al. | 2016 | Administration of R. serpentina to hypertensive rats resulted in a reduction in systolic and diastolic blood pressure. |
| 18. | Individualised homoeopathic medicines in stage I essential HTN: A double-blind, randomised, placebo-controlled pilot trial.[31] | Sadhukhan et al. | 2021 | An adequately powered efficacy trial was recommended. Pulsatilla nigricans, Natrum muriaticum and T. occidentalis were used. |
HTN: Hypertension, T/CAM: Traditional, complementary and alternative medicine, L. muta: Lachesis muta, R. serpentina: Rauwolfia serpentina, T. occidentalis: Thuja occidentalis, L. clavatum: Lycopodium clavatum, V. album: Viscum album, A. metallicum: Aurum metallicum
DISCUSSION
Homoeopathy has numerous resources that can be utilised in preventing and managing essential HTN. Homoeopathic management can be broadly categorised into two groups: the classical approach and a continuously updating research outcome. In the 1st category, thorough case-taking is done to extract characteristic, clear-cut symptoms, after which a totality of symptoms is constructed. Medicine matching the totality of symptoms is prescribed. When the totality of symptoms is used, any medicine may be indicated. Where the symptoms related to HTN can be matched with keynotes of the medicine, it is termed a keynote prescription. Even in cases where characteristic or keynote symptoms can not be deduced, and the pathological prescription is preferred, there must be some indications for a particular medicine among many. Factors, such as accessory circumstances, predominant miasm, and probable cause must be considered while adopting the classical approach.
Hypertensive cases present in two groups: newly diagnosed cases not on any anti-hypertensive drugs and long-standing cases taking anti-hypertensive drugs. In both conditions, one should give the medicine as per symptoms similarity after proper case taking. Anti-hypertensive drugs must not be stopped abruptly, they can be tapered off after the patient responds well to homoeopathic treatment.
Along with medication, lifestyle changes must be implemented, including exercising at least 30 min a day, reducing sodium (salt) intake, increasing potassium intake, limiting alcohol consumption, consuming a diet rich in fruits, vegetables, and low-fat dairy products, and reducing total and saturated fat intake.
So far, numerous studies having different study designs as double-blind, randomised placebo-controlled trials, single-arm studies, cross-sectional studies, retrospective cohort studies, surveys, and reviews, have been conducted exploring the effectiveness of homoeopathic medicines in controlling essential HTN. However, none of the studies reported that homoeopathy was equivalent or superior to conventional medicine in controlling HTN. Individualised homoeopathic treatment was found effective in some of the studies, but reproducibility was lacking. Jack reported a dramatic improvement in the health of a hypertensive patient after using S. scoparium in tincture form. Bignamini et al. reported that four subjects who had been considered sensitive and were treated with Baryta carbonica gave strongly positive results.[22] Poruthukaren et al.’ found a significant drop in blood pressure (P < 0.0001) in the treatment group with V. album.[24] Sharma et al. observed that L. muta 30C significantly reduced the blood pressure level in patients with essential HTN.[25] In a non-randomised single arm study, Natrum muriaticum 30C significantly reduced the blood pressure level in patients with essential HTN. In an experimental study, Kumar observed that R. serpentina reduced systolic and diastolic blood pressure in hypertensive rats.[30] Apart from these, many more medicines have been mentioned in homoeopathic literature whose symptomatology is similar to the symptomatology of essential HTN. Therefore, the scope of research for exploring their effectiveness is the only way forward. Researchers need to conduct studies with sufficient statistical rigour to delineate the efficacy of those medicines to enable their use in managing HTN.
CONCLUSION
Homoeopathy is becoming increasingly popular, even for managing conditions such as HTN and its complications. Hence, proper knowledge of how to manage this condition effectively is crucial. In homoeopathic therapeutics, many medicines are recommended for the different symptoms of HTN. Auxiliary measures such as lifestyle modification are important when managing essential HTN. In recent years, the frequency of homoeopathic research publications on this particular condition has increased considerably; however, more randomised or nonrandomised controlled trials, open-label studies, comparative studies and multicentric trials are needed to further understand the optimum utilisation of homoeopathy in HTN.
Ethical approval
The Institutional Review Board approval is not required.
Declaration of patient consent
Patient consent was not required as there are no patients in this study.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship
Nil.
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