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Incorporating Hahnemannian principles in the practice of tele-homoeopathy: Current scenario and future possibilities
*Corresponding author: Yogesh Dhondiraj Niturkar, Department of Organon of Medicine and Homoeopathic Philosophy, Vasantrao Kale Homoeopathic Medical College and Hospital, Latur, Maharashtra, India. yogeshdn@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Niturkar YD. Incorporating Hahnemannian principles in the practice of tele-homoeopathy: Current scenario and future possibilities. J Intgr Stand Homoeopathy 2021;4(1):20-8.
Abstract
Objectives:
The COVID-19 pandemic prevented people from accessing medical care in person; in such a scenario, telemedicine emerged as a boon. Telemedicine helped to increase the availability of homoeopathy during the pandemic. The Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) formulated guidelines to enable registered homoeopathic practitioners (RHPs) to safely provide healthcare using telemedicine. In this study, we demonstrated the scope of telemedicine in homoeopathic practice by incorporating Hahnemannian principles in a case-based learning (CBL) module.
Materials and Methods:
A retrospective purposive study was conducted on 10 acute cases that were treated with homoeopathy through telemedicine during the COVID-19 lockdown. Patient-physician communications were analysed using Hahnemannian principles. Cases were assessed based on telecommunication application, type of consent, symptoms, signs, nosological provisional diagnosis, risk assessment, comorbidity, miasm and susceptibility status, totality of symptoms, repetition strategy and type of consult. Therapeutic management included building a logical framework of the case and auxiliary counselling. Patients were followed up to determine their health status.
Results:
All 10 cases were successfully treated with homoeopathy using AYUSH Telemedicine Practice Guidelines (ATPG) and incorporating Hahnemannian principles. Tele-homoeopathy was found to be effective in the pandemic by preventing disease spread and progression from mild to severe stage.
Conclusion:
Adhering to the ATPG and incorporating Hahnemannian principles can be effectively demonstrated through CBL modules; these enable RHPs to develop rational thinking and learn from clinical experiences.
Keywords
Ayurveda
Yoga and Naturopathy
Unani
Siddha and Homoeopathy
Case-based learning
COVID-19
Pandemic
Tele-Homoeopathy
Telemedicine
INTRODUCTION
Telemedicine means ‘healing at a distance.’ It uses information technology for improving patient outcomes by increasing access to healthcare and medical information. As this science responds and adapts to the changing health needs and contexts of societies, it is continuously evolving.[1] It is increasingly becoming a tool for convenient medical care.[2] Telemedicine is efficient and cost effective, especially in the midst of the current COVID-19 pandemic. It permits a two-way, real-time interactive communication between the patient and the physician who may be at a distance.[3]
The homoeopathic fraternity has been quick and responsive to offer preventive and curative treatment options during the COVID-19 pandemic.[4] Patients with COVID-19 exhibit a wide range of symptoms. The management strategy comprises following preventive measures, educating people about said general measures and providing immunity enhancing interventions. The second step is to provide homoeopathic symptomatic mitigation to affected people.[5]
To ensure effective management of COVID-19 and its associated impact, telemedicine practice guidelines for homoeopathy were formulated by the Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH).[6] These guidelines can be effectively demonstrated through case-based learning (CBL) modules. CBL is a teaching method that fosters analytical and problem-solving skills.[7] CBL modules help to build a logical framework and in perceiving the concept, as stated and demonstrated by different homoeopathic stalwarts. Effective CBL for tele-homoeopathy can become an integral part of the homoeopathic practice in view of living up to the first 6 aphorisms in particular as well as other principles mentioned by Hahnemann in the Organon.[8] The COVID-19 pandemic gave impetus to the establishment of a new virtual medical world order[9] and an opportunity to explore the scope of tele-homoeopathy in the current scenario and its future possibilities.
MATERIALS AND METHODS
A retrospective purposive study was conducted on 10 acute cases that were treated with Homoeopathy through telemedicine during the COVID-19 lockdown. Patient-physician communications were analysed using Hahnemannian principles. Cases were assessed based on telecommunication application, type of consent, symptoms, signs, nosological provisional diagnosis, risk assessment, comorbidity, miasm and susceptibility status, totality of symptoms, repetition strategy, and type of consult. Therapeutic management included building a logical framework of the case and auxiliary counselling. Patients were followed up to determine their health status. All ten case reports are given below in the form of caselets.
Case reports (In the form of caselets)
Caselet 1
Demonstration of how telemedicine consultation and the homoeopathic clinical investigation, if rightly evaluated and acted upon, yields results.
Opening of interview
Mr. YZ, a 40-year-old businessman a Known Case of (K/C/O) chronic allergic rhinitis, was under homoeopathic management with Calc Carb 200 a weekly single dose at bedtime. He provided oral implicit consent for telephonic consultation.
Body of the interview
The patient’s complaints were (a) sudden fear of contracting COVID-19 as one new case has been identified in his vicinity, (b) anxiety for his 6-month-old son, (c) worried about what will happen to his family if they contract the disease, (d) anxiety felt in and around the chest and (e) 2–3 episodes of loose motions in small quantities with generalised weakness and exhausted feeling.
Interview plan (IP)
Based on the patient’s narrative, the physician formulated the IP and enquired specifically about consumption of Ars alb 30 as a prophylactic medicine. The patient confirmed it. The physician had asked this specific question as the panic generated by COVID-19 had led to free distribution and over-the-counter availability of Ars alb, often leading to unnecessary repetition without any medical supervision.
Logical framework
The physician needed to conduct an anamnesis of the case information available through telecommunication. Further, integration of the chief complaints, COVID-19 and pre- or post-Ars alb consumption questionnaire will reflect the physician’s skills.
Case analysis
Quick assessment for patient evaluation can be formulated using problem definition (PD) in terms of identifying the cause, evolution and expression of disease; this helps to form the totality of symptoms (TOS), [Table 1].
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Remedies covering the TOS
Ars alb (14/5), Calc carb (11/4), Phos (10/4), Carc (8/3) and Arg nit (8/4).
Ars covered the totality and there was a recent history of Ars alb 30 consumption as a prophylactic. Therefore, this was deemed to be a proving of Ars alb, as ‘all medicinal substances have the power of causing disease when given to persons in health.’[10]
Action
Antidote.
Antidote selection
Close remedies: Nux v (7/5) and Camphora (6/5).
Differentiation was done by understanding the Ars alb remedy relationship[11] with Nux v and Camphora as well as the patient’s constitutional remedy (Calc), [Table 2].
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Nux v and Camphora are both antidotes that cover the TOS. However, on studying the Materia Medica, we can select the antidote using the principles of arriving at a Similimum. Ars alb is followed well by Nux v, it also follows Calc and Nux v. Moreover, it is similar to Calc and Nux v and is antidoted by Camphora and Nux v. Fear, phobias and disease impending, which were the qualified characteristic mental symptom that predominantly affected the patient and led to other expressions, are covered by Nux v [Table 3].
| S. No. | Rubrics | Nux vomica 7/5 | Camphor 6/5 |
|---|---|---|---|
| 1 | Fear, phobias, disease, of impending | 2 | - |
| 2 | Anxiety, general, family, about his | - | - |
| 3 | Anxiety, general Chest felt in the | 2 | 3 |
| 4 | Anxiety, general, diarrhoea, from | 1 | |
| 5 | Weakness, general, fatigue, exhaustion, low vitality | 3 | 2 |
Therapeutic management
Nux v 200C single dose.
Follow-up consult (remedy response evaluation)
The patient felt somewhat better within an hour of the dose. On day 2, he was fully restored to health.
Learning
Significance of history taking through the telephone, formulation of PD, problem resolution, IP,[12] and study of remedy relationship and remedy response evaluation.
Caselet 2
Demonstration of demands on the homoeopathic physician to understand the patient as a person and importance of perceiving disease response as the patient’s adaptation to time and circumstances.[13]
Opening of the interview
A 40-year-old female patient provided oral implicit consent for tele-homoeopathy. She complained of (a) cough in the throat pit for 5–6 days, aggravated day and night, (b) non-productive cough with dryness of throat with mild increase in thirst and (c) anti-allergic and antitussive medication prescribed by her dentist husband, which provided partial relief.
Body of the interview
The patient’s husband is a dentist and had started attending his clinic since a week. He is ostensibly at risk of exposure to COVID-19 and its potentially fatal outcome. This worsened the patient’s anxiety about her and her children’s future. This led to the primary emotional expression of anxiety; she tried to get her husband to avoid going to the clinic, but he did not agree. Conversely, she also felt that if the husband will not work, their daily needs will not be fulfilled.
Logical framework
Physician should investigate areas of potential conflicts to trace the cause-effect relationship.
Case analysis
The problem was defined through telecommunication; the conflict due to the expectation from husband to avoid attending his clinic was concluded. The type of conflict was approach avoidance that is, fulfilling daily needs by avoiding risk factors and without undertaking any efforts. The emotions generated were anxiety and fear of impending disease having a psychosomatic correlation in the form of psychogenic cough that is, a mental symptom causing a physical expression. The diagnosis was psychogenic cough (ICD 10 F45.8 Other Somatoform Disorders). Based on the narrative and interpretation, the TOS was formed. The repertorial result showed Phos (15/5), Ars alb (14/4) Hep sulph (12/4), Nit ac (12/4) and Rhus tox (12/4), [Table 4].
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Remedy differentiation was done on the basis of rubric anxiety, cough from (cough due to anxiety); Phos and Nit ac cover this rubric. Anxiety about the family is the core concern of the patient, which is not covered by Nit ac; hence, Phos was the remedy selected. The patient is hypersensitive toward her husband’s well-being; the emotional expression of anxiety causes conflict and psychogenic cough. Other prominent symptoms were perception acute, thinking emotional and readily receives various environmental stimuli and reacts to them sharply. As the susceptibility and sensitivity were high; the 1 M potency was selected.
Therapeutic management
Phos 1 M thrice a day (TDS) for 3 days.
Follow-up consult
The physical complaints diminished and conflict resolution occurred: The patient supported her husband in continuing his medical services.
Learning
Significance of observations in telemedicine (a) enhances the process of learning, (b) helps in perceiving the facts as given in the Materia Medica and (c) helps in developing correlations with clinicopathologic and psychopathologic concepts.
Caselet 3
Demonstration of the importance of operational knowledge and practice demands with respect to collection of data as well as its standard recording and subsequent processing to draw valid conclusions.[14]
Opening of the interview
The patient is a 2-year-old male child. Oral implicit consent was provided by his father during the communication. The patient’s mother observed in him sudden swelling of the penis, dribbling of urine and the consequent soiling of the genital area. They consulted a paediatrician, but the complaints persisted because the patient regurgitated the allopathic medicines. The child’s abdominal distension increased at night, so the father sent the physician a message on WhatsApp at 1:42 am and then called up at 1:45 am.
Body of the interview
The telephonic transactional record had mention of (a) swelling of the penis and unable to pass urine since evening, (b) dribbling of urine, (c) fever of moderate degree, (d) offensive discharge and (e) child is comfortable.
The negative data in this case were (a) no chilliness, (b) no crankiness/irritability, (c) feeding or intake was normal and (d) on examination, there was no abdominal distension/ tenderness, [Figures 1 and 2].
- Day 1 swelling at the shaft of penis.
- Allopathic prescription.
Case analysis
Disease diagnosis: Oedema of the penile shaft (ICD-10 N48.29: Other Inflammatory Disorders of Penis). The patient’s general vitality was good. The therapeutic goal was to provide instant relief with an expected outcome of restricting pathological progression and avoiding further surgical intervention.
Advice
Ultrasonography and surgical opinion, if required.
Repertorial result
Merc (18/6), Thuja (18/6), Hyoscyamus (17/5), Nat sulph (17/5) and Nat mur 15/4. All remedies were close in the totality coverage [Table 5].
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Potential differential field
The rubric urine, dribbling by drops was selected; Merc is 4 marks and Thuja is 3 marks.
Therapeutic management
Merc 200 3 pills 4 times a day (QDS) for 3 days.
Follow-up consult
The father reported that within 45 min after the first dose, the patient passed urine with some mucus and slept peacefully. On day 2, the patient was asymptomatic, [Figure 3].
- Day 2 after homoeopathic intervention.
Learning
Telemedicine accelerates health care availability in emergency medicine and it further allows the provider to explore the possibilities of homoeopathy.
Caselets 4, 5, 6 and 7
Learning how to enhance professional competence through the application of homoeopathic theory into practice.
Opening of the interview
A 44-year-old man provided implicit consent for telehomoeopathy for himself and his entire family. Dr. G, a paediatrician (Case 4), a K/C/O diabetes mellitus (DM) Type II on Oral Hypoglycaemic Agents (OHAs). The patient’s wife Dr. N (Case 5), a gynaecologist by profession and a K/C/O bronchial asthma, is under homoeopathic treatment. Laboratory test was not done. Case 6 is 12 years old, a K/C/O attention deficit hyperactive disorder under homoeopathic treatment. Case 7 is an 8-year-old healthy child.
Body of the interview
The reason for telephonic consultation was the underlying worry and anxiety as Cases 4, 5, and their staff came in contact with COVID-19-positive cases and their hospital was in a containment zone. One month prior, the patient and his family had a history of Ars alb 30 consumption procured from a registered homoeopathic practitioner (RHP). Case 4 presented with C/O body ache, Case 5 had throat pain with dryness and Case 6 had played in the rain and was feverish. Case 7 was healthy.
Case processing
From the available data, the following interpretation was done.
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Case 4: (1) Comorbidity – DM Type II, (2) high-risk contact: History of exposure to COVID-19-positive patient and hospital in containment zone and (3) acute presentation as body ache
Provisional diagnosis: Myalgia (ICD 10 Code M79.1)
Action: Bryonia 200 3 pills QDS × 3 days
Advice: Real-time polymerase chain reaction (RTPCR). The patient decided to wait and watch.
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Case 5: (1) Comorbidity – bronchial asthma, (2) mild risk contact: History of exposure to COVID-19-positive patients and hospital in containment zone and (3) acute presentation as throat pain with dryness
Provisional diagnosis: Acute tonsillitis (ICD 10 Code J03.9)
Action: Merc 200 3 pills QDS × 3 days
Advice: RT-PCR (patient decided to wait and watch instead of being a high-risk contact: Implicit consent).
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Case 6: (1) Low-risk contact, (2) acute presentation as feverish, ailments from playing in rain
Provisional diagnosis: Nothing specific. To wait and watch for symptom development
Action: Rhus tox 200 3 pills QDS× 3 days
Cases 4, 5 and 6 were followed up with Camphora 1M 1 dose at bed time as a prophylactic.
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Case 7: (1) Low-risk contact and (2) asymptomatic.
Provisional diagnosis: No diagnosis (ICD 10 Code Z71.1)
Action: Camphora 1 M 1 dose at bed time as a prophylactic.
Follow-up consult
All the patients have been restored to health.
Conclusion
Cases 4 and 5: Mild disease, high-risk contact with underlying comorbidities. Cases 6 and 7: Mild disease, low-risk contact.
Logical framework
Medicine to be selected as per the stage and presentation of disease and symptomatic similarities in view of symptomatic amelioration and mitigation.
Learning
Applied telemedicine demonstrates how symptomatic amelioration and mitigation can be achieved with the aid of homoeopathy.
Caselets 8, 9 and 10
Demonstrating how to proceed in the study of homoeopathy by integrating various disciplines available for the study of man in health and disease.[15]
Case 8
Opening of the interview
Dr. B 40 years, working in the National Rural Health Mission, Dept. of AYUSH initiated telecommunication. Patient is a K/C/O DM Type II on OHAs.
Body of the interview
He had a single episode of high-grade fever; he underwent the COVID-19 rapid antigen test and tested positive. Subsequently, he was asymptomatic.
His father and mother tested negative. On enquiry, the patient was afebrile, but had mild body ache. During conversation, the RHP felt that the patient is psychologically healthy. He was institutionally quarantined in a COVID-19 centre.
Conclusion
Mild disease with high contact risk having comorbidity with acute presentation of fever and body ache.
Diagnosis
COVID-19 +ve (ICD 10 Code U07.1).
Action
Bryonia 200 3 pills QDS × 5 days.
As the patient was asymptomatic, there was no intervention of allopathic treatment.
Cases 9 and 10
The RHP who handled these cases is the family physician to Case 8; therefore, he obtained explicit consent and initiated telecommunication to assess the overall status of Cases 9 and 10.
Case 9 is the mother of case 8, 58 years old, a K/C/O DM Type II and osteoarthritis. Case 10 is the father of Case 8, 62 years old, a K/C/O asthma and lumbar spondylosis. On enquiry, Cases 9 and 10 were found to be asymptomatic and psychologically stable. Both had history of high-risk contact but tested negative for COVID-19.
Conclusion
Mild disease with high contact risk and underlying comorbidity.
Action
Family psychotherapy and health education.
Learning
Telemedicine in homoeopathy can accelerate the healing process with medicines and ancillary measures.
RESULTS
All 10 cases were successfully treated with Homoeopathy using AYUSH telemedicine practice guidelines (ATPG) and incorporating Hahnemannian principles. TeleHomoeopathy was found to be effective in the pandemic by preventing disease spread and progression from mild to severe stage.
DISCUSSION
Ten cases were selected in which tele-homoeopathy was practiced as per the AYUSH telemedicine practice guidelines (ATPG) and Hahnemannian principles. The telecommunication applications used were audio, text based and visual photos. In 8 cases, the telecommunication process was initiated by patients, providing implicit consent; in 2 cases, it was initiated by RHP after obtaining explicit consent. The timing of information transmitted was of non-emergency nature in 2 cases (1 and 2), emergency in 2 cases (3 and 8) and non-emergency with a probability of becoming emergency in 6 cases (4, 5, 6, 7, 9 and 10). Apart from 3 cases (2, 3 and 7), the remaining 7 had comorbidities. Miasmatic predominance of Psora followed by Sycosis was observed. Susceptibility was high in 3 cases and moderate in 7 cases. Remedial selection was based on stage, presentation and severity of disease as well as symptomatic similarity. Therapeutic intervention was done in view of symptomatic amelioration and mitigation. The predominant remedies prescribed were Nux v (Case 1), Phos (Case 2), Merc (Cases 3 and 5), Bryonia (Cases 4 and 8), Rhus tox (Case 6) and Camphora (Case 7 and in Cases 4, 5 and 6 as a prophylactic medicine). Remedial intervention with ancillary measures was advised in 8 cases and non-remedial that is, family and health education in 2 cases (Cases 9 and 10). In Cases 4, 6, 7 and 8, there was paucity of symptoms and the remedial selection (Bryonia, Camphora and Rhus tox) was done as per the suggested therapeutic aid according to the different stages of disease mentioned by AYUSH. Single repetition of medicine was done in 2 cases (Cases 1 and 7) and multiple repetitions were done in 8 cases. Follow-up consultation was done as per the need of each individual case. Despite comorbidities occurring in 7 cases, all 10 cases had favourable outcomes, achieved in a cost-effective manner [Table 6].
| Case | 1 | 2 | 3 | 4 to 7 | 8 | 9 | 10 |
|---|---|---|---|---|---|---|---|
| Telecommunication applications (mode of communication) | Audio | Audio text based visual photo | Audio | Audio | Audio | Audio | |
| Tele consultation process | Initiated by patient→Registered homoeopathic practitioner | Initiated by registered homoeopathic practitioner→Patient | |||||
| Type of consent | Implied | Explicit | |||||
| Type of consult | First and follow-up consult | ||||||
| Timing of info transmitted | Non-emergency | Emergency | Non-emergency→Emergency | Emergency | Non-emergency→Emergency | ||
| Diagnosis/provisional diagnosis | Drug proving | ? Psychogenic cough | Oedema of penile shaft | 4. Myalgia | COVID-19 + | No diagnosis (ICD 10: Z71.1) | |
| 5. Tonsillitis | |||||||
| 6. No diagnosis | |||||||
| Miasm | Psora | Psora | Sycosis | Psora? Tubercular | Sycosis | Psora? Sycosis | Psora? Sycosis |
| Comorbidities | Chronic allergic rhinitis | None | None | 4: DM Type II 5: Chronic asthma 6: Attention deficit hyperactive disorder 7: None |
DM Type II | DM Type II | Chronic asthma lumbar spondylosis |
| Stage of disease | Acute | ||||||
| Prognosis | Favourable | ? Unfavourable | Unfavourable →Favourable | Unfavourable | Unfavourable → Favourable | ||
| Susceptibility | Moderate | High | Moderate | High | High:- 5, Moderate:- 6,7,8, |
Moderate | |
| Repetition | Single | Multiple | Multiple: 4,5,6 Single: 7 | Multiple | Multiple (3) | ||
| Patient management prescribing medicines | Nux V | Phos | Merc | Bry: 4, Merc: 5 Rhus t: 6 Followed by Camp 1M Camp 1M: 7 |
Bry 200 | Non-remedial Family Psychotherapy Health Education |
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| Outcome | Good-Favourable | ||||||
CONCLUSION
ATPG in homoeopathy (tele-homoeopathy) can be effectively applied in the COVID-19 pandemic. It helps prevent the spread of disease and aborts disease progression from mild to severe, irrespective of comorbidities and the nature of disease – emergency or non-emergency.
Adhering to the ATPG and incorporating Hahnemannian principles can be effectively demonstrated through CBL modules, enabling the RHP to develop rational thinking and learn from clinical experiences to benefit patient care.
Acknowledgments
I sincerely thank Dr. Kumar M. Dhawale and Dr. Nikunj Jani for their patience, assistance and valuable guidance in preparing this manuscript.
Declaration of patient consent
Patient’s consent not required as patients identity is not disclosed or compromised.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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