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Case Report
6 (
2
); 79-85
doi:
10.25259/JISH_57_2023

Role of homoeopathy in neurological disorders highlighting importance of 10W’s and plussing method

Department of Homoeopathy, Ananda Wellness, Mumbai, Maharashtra, India
Corresponding author: Dr. Furqan Ismail Qureshi, Department of Homoeopathy, Ananda Wellness, Mumbai, Maharashtra, India. dranand.mumbai@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Anand SR, Qureshi FI. Role of homoeopathy in neurological disorders highlighting importance of 10W’s and plussing method. J Intgr Stand Homoeopathy 2023;6:79-85.

Abstract

Diseases of the nervous system are some of the most challenging to treat in medical practice. However, they can be even more challenging when treating with homoeopathy. The sensation or the subjective symptoms on which we rely to a great extent are often altered in nervous system disorders – either heightened sensations (e.g., hyperesthesia) or complete loss (e.g., paralysis). Therefore, it becomes all the more important to have a complete and detailed picture of the disease in its entirety to have a solid ground to base your prescription. The utility and accuracy of 10W’s in case taking are aptly highlighted in such cases. Here, we present a case of a 37-year-old male who developed right eyelid ptosis as sequelae of tubercular meningitis. Along with this, he also had other neurological symptoms of lack of control over urination and vertigo. The case was taken on the guidelines of 10 Ws and successfully treated using the homeopathic medicine Zincum metallicum which was administered using the plussing method.

Keywords

Homoeopathy
Neurological disorders
Ptosis
Tubercular meningitis
Plussing method
Zincum metallicum

INTRODUCTION

Neurological disorders are defined as structural, biochemical, or electrical abnormalities in the brain and/or spinal cord and peripheral nervous system.

Classification of neurological disorders

For ease of understanding, neurological disorders can be broadly classified into the following categories based on their pathogenesis:

  • Neurodevelopmental: Attention deficit hyperactivity disorder, autism, speech, and language disorders, and Tourette syndrome[1,2]

  • Neurodegenerative: Alzheimer, Parkinson disease, muscular dystrophy/atrophy, and Huntington disease[1,2]

  • Neurometabolic: Wilson diseases, phenylketonuria, homocystinuria, and pyridoxine dependency[1,2]

  • Neurological infections: Encephalitis, meningitis, brain abscess, cysticercosis[1,2]

  • Neoplasms: Glioma, astrocytoma, ependymoma, oligodendroglioma, and gliosarcoma[1,2]

  • Cerebrovascular: Stroke, carotid stenosis, aneurysms and vascular malformations.[1,2]

Secondary neurological signs and symptoms can occur due to disorders of other body systems, such as head injuries and Vitamin B12 deficiency.

In this article, we will be discussing homoeopathic management of neurological conditions arising as a complication of neurological infections with the help of a case example.

Ptosis

Ptosis or blepharoptosis is drooping or falling of the upper eyelid. It can be of two types – myogenic and neurogenic. Myogenic ptosis occurs when there is an injury or trauma to the levator palpabrae superioris (LPS) muscle. Neurogenic ptosis can occur due to head injuries, neurotoxins, injury or conditions affecting the oculomotor nerve, which supplies the LPS.[3]

Tubercular meningitis

It is a bacterial infection of the meninges caused by Mycobacterium tuberculosis.[4]

Signs and symptoms[4]

  1. Fever

  2. Headache

  3. Nuchal rigidity

  4. Photophobia

  5. Focal neurological deficits may be present

  6. Kernig’s and Brudzinski’s signs are positive.

Complications[4]

  • Stroke

  • Seizures

  • Monoplegia

  • Hemiplegia

  • Deficits in the cranial nerves.

The case history has been narrated in the form of 10 W’s – An extension of Boenninghausen’s 7 W’s, which is extensively used as a case taking method by the authors in their practice. The importance of each ‘W’ has been highlighted below.[5,6]

Importance of 10 W’s – An extension of Boenninghausen’s 7 W’s

Let us understand how having the case in the 10W’s format helps in better understanding

Who? Quis

The homoeopath must know WHO they are treating if they wish to understand the cause of the derangement of the health of the patient. The personality and individuality of the patient must stand at the head of the image of the disease. The bodily constitution, miasmatic spectrum, temperament, interest, and hobbies are the factors that define the WHO for us.

What? Quid

It is essential to know the kind of disease and the stage of disease we are treating, so we need to know the nature and peculiarity of the disease.

Where? Ubi

It is important to the seat of the disease. Where are the symptoms located? On what level are the characteristic signs and symptoms found, physical, vital, or mental plane?

With What? Quibis Auximis

The concomitant symptoms appear in the patient synchronistical to the main complaint. The concomitant is the totality of what aggravation and amelioration are to individual symptoms. They help us form a complete picture of the disease.

Why? Qur

The cause of the disease is very important to study because it helps in choosing a proper homoeopathic remedy, managing the case, and removing the obstacles to cure. Homoeopathy sees cause and effect as two sides of the same phenomenon. Cause and effect are functional polarities that appear and disappear together.

What effects? Quomodo

This relates to the modalities that make something better or worse. It includes factors such as air, pressure, motion, eating, and drinking.

When? Quando

This section studies the chronological development of the disease and the complete case history. Knowing this helps us to trace Hering’s law of direction of cure.

Watch out for!

This includes the subjective signs and symptoms: The gestures, body language, energy and doodles.

Which kingdom?

Classification of the patient in the process of case taking helps us to narrow down the search of the similitude to a group of remedies. Broader classification according to prime features of the kingdoms, like structure for minerals, survival for animals, sensitivity for plants, desperation for nosodes, exaggerated organ association for sarcodes, and infinite and immaterial themes for imponderabilia.

Once the kingdom is classified further narrowing down to the rows and columns (mineral kingdom) or subkingdom of animals and plants helps us to reach the similimum with accuracy.

What intensity?

The maism has to be settled on before searching for the remedy. The drug must match the pace, nature and pathology of the disease.

CASE REPORT

Patient information

The patient is a 37-year-old Muslim male working in a call centre who recently had meningitis and now has right ptosis.

1) Who?

Lives with his parents, wife and two daughters. Has completed B.Com and works at a call centre in the night shift.

Childhood: Used to play indoor games. Was not allowed to go out and play. Frequent tonsillitis especially during examinations. Was the eldest child, so was pampered by the grandparents. Was average in studies. Did not enjoy studies. Loved reading horror novels.

Anger: When contradicted. Shouts if angry. Anger and irritation at trifles.

Loves being around people. Extrovert. Mixes with people easily. Enjoys his work. Says that the night shift does not bother him.

Fear of being alone.

Fear of cats, cockroaches, and high places.

Feels active more at night even during childhood days.

Good confidence and leadership skills. Has 12 people working under him. He is the tech leader.

Love for horror movies and stories.

Anxiety – time set.

Does not share his problems or emotions with anyone.

Restlessness ++ constant needs to change place.

Gets irritated when someone keeps asking him things to do in a certain way.

2) What?

Started with toothache, fever, and headache. Went to the dentist and took medication, which relieved fever and headache. Had dental caries, due to which tooth extraction was done on November 05, 2019. After the extraction, the fever increased and started developing ptosis of the right eyelid along with restlessness and loss of control over urine. His blood pressure shot up to around 250 mmHg systolic. He was hospitalised and investigated, after which a diagnosis of tubercular meningitis with diabetes mellitus and hypertension. He was started on anti-Koch’s therapy.

Now

  • Loss of control over urination for 1 month

    Currently catheterized

    Urine – Orange.

  • Ptosis of the right eyelid for 1 month

    Diplopia in the right eye upwards and downwards

    Loss of power of eye muscles

    Cannot walk properly, Loss of balance and needs

    support to walk.

  • Vertigo for a month

    <Staring at a point for 30–40 s

  • Lower back pain for 3 weeks

    <Lying on back for too long

    <Sitting >Pressure

    >Hot fomentation

3) Where?

  • Nervous system

  • Musculoskeletal system

4) When?

  • Nervous system

    • Loss of control over urine for 1 month

    • Ptosis for 1 month

    • Vertigo for 1 month

  • Musculoskeletal system

  • Lower back pain for 3 weeks

5) With what?

Appetite – Decreased, wanting appetite, feels food is tasteless

Thirst – 5–6 glasses/day

Craving – Fish+++/Chicken++, salty food

Aversion – Bitter things/bitter gourd

Perspiration – Face/back

Stool – Irregular bowel movements

Urine – Orange (due to medicines?)

Sleep – Disturbed, due to back pain, sleeps on the right side, snoring

Dreams – Does not remember

6) What effects?

Vertigo < sitting < staring at one point

Backache < sitting

<Lying on back for too long

>Pressure

>Hot fomentation

7) Why?

A/F – tubercular meningitis

Tooth extraction?

Medical history

Meningitis at 37 years of age

Car accident – right hand fracture – at 32 years of age

Measles – 6 and 10 years of age

Mumps – 5 years of age

Whooping cough? – 4 years of age

Chickenpox – 3 years of age

Family History

Father – Diabetes mellitus

Mother – Hypertension/Rheumatism/Hyper-cholesterolaemia/Diabetes mellitus

Grandfather (P) – Anaemia/Tuberculosis/Asthma

Grandmother (P) – Diabetes mellitus/Hypertension/Chronic kidney disease

Grandfather (M) – Arthritis

Grandmother (M) – Diabetes mellitus/Hypertension/Chronic kidney disease

8) Watch out!

9) Which kingdom? (Discussed later)

10) Which remedy? (Discussed later)

Clinical findings

Pulse – 88/min

BP – 140/90 mmHg

Weight – 74.5 kg

RS – AEBE, Clear

CVS – No abnormalities detected

Eye Examination

Right eye – Ptosis

Vision – Central and peripheral visual fields normal

No other visible deformities or opacities.

Totality – Boenninghausen’s method

QUIS – Personality (Mental Generals)[6]

  • Anger from contradiction, at trifles

  • Fear of being alone

  • Fear of high places

  • Anxiety

  • Restlessness

QUID – The disease[6]

  • Ptosis of right upper eyelid

  • Involuntary urination

  • Backache

UBI – Seat of disease[6]

  • Eyes – Eyelids

  • Central Nervous System – Meningitis/vertigo

  • Bladder

  • Back

QUIBIS AUXALIS – Accompanying symptoms[6]

  • Vertigo – staring or looking at point continuously

  • Urine – orange

  • Desires chicken

  • Desires fish

  • Desires salty food

CUR – Cause of disease[6]

  • Meningitis

  • Tooth extraction

QUOMODO – Aggravation and Amelioration[6]

  • <Sitting

  • <Staring at one point

  • <Lying on back for too long

    • Pressure

    • Hot fomentation

QUANDO – Time

Rubrics – Boger Boenninghausen’s Characteristics and Repertory (BBCR) [Figure 1]

Figure 1:
Repertory sheet 1 – All remedies.[12]

Mind – Anger, crossness:

Mind – Anxiety, agony:

Mind – Fearsome, anxiety, dread, frightened easily: Alone, of being:

Mind – Restlessness:

Eyes – Eyelids: Paralysis, drooping, ptosis:

Upper:

Urine – Micturition: Urination:

Involuntary:

Back – Lumbar region: Pain:

Vertigo – Vertigo:

Appetite – Desire for: Salty things:

Appetite – Desire for Fish:

Head – Internal: Inflammation: Meningitis:

Aggravation and Amelioration – Sitting: Agg.:

Aggravation and Amelioration – Lying: On back: Agg.:

Aggravation and Amelioration – Pressure: External: Amel.:

Aggravation and Amelioration – Cold: In general, agg.:

Aggravation and Amelioration – Looking: Intently, fixedly, straining the vision, agg:

Analysis and synthesis

Let us go back to Questions 9 and 10

Which Kingdom?

From history, it is evident that he is a workaholic, achiever, and performer. Therefore, the themes of responsibility, leadership, role, and performance are marked, which point to the mineral kingdom. This can be differentiated from the animal kingdom where there will be more energy put into survival, which will be seen as competitiveness, attack, and defence at the workplace, all of which are not present in this case.

What Intensity?

A very reliable indicator of the intensity and pace of disease is the dominant miasm. The dominant features of this particular case are post-tubercular sequelae, rapid progress into deeper pathology, and infection leading to nerve damage causing ptosis. Moreover, from history, the features of restlessness with a constant desire to change and the desires for chicken and fish are strong indicators of tubercular miasm.

Differentiation and selection of remedy

Now with these two answers – Mineral kingdom and Tubercular miasm, we now look at the repertorial analysis after applying the Mineral and Tubercular remedy filter and narrowing down on the mineral kingdom remedies. [Figure 2]

Figure 2:
Repertory sheet 2 – Mineral kingdom remedies (mineral kingdom and tubercular remedies filter applied).[12]

The top mineral kingdom remedies are –

Phosphorus (Row 3 Column 15)

Sulphur (Row 3 Column 16)

Causticum (Potassium) (Row 4 Column 1)

Arsenic alb (Row 4 Column 15)

Calcarea carb (Row 4 Column 2)

Silicea (Row 3 Column 12)

Natrum mur (Row 3 Column 1)

Nitric acid (Nitrogen) (Row 2 Column 15)

Zincum (Row 4 Column 12)

Going in details of the features of these Rows,[7] we see that Row 4 corresponds most to the case. Therefore, now we narrow down to Causticum, Calcarea carb, Arsenic alb and Zincum. The column analysis shows that the features of column 12 are in correspondence with the case.

Features of Row 4[7]

Themes of Security and Task. Security is often searched for in terms of money, relationship, job, and health. ‘There is an attack and he has to defend himself.’

The keywords of Row 4 are – Security, Protection, Attack, Safety, Defence, Job, and Task.

Features of Column 12[7]

There is constant attack to the structure and there is constant fight to prevent damage. Constant vigilance, alertness, and restlessness.

The Keywords of Column 12 are – Threat, Attack, Alert, Struggle, and Unsuccessful efforts.

From the Materia Medica reference, the supporting points in favour of Zincum over Causticum, Calcarea, and Arsenic alb are

Kent’s Materia Medica – Zincum metallicum[8]

….after badly treated meningitis; tubercular meningitis.’

Boericke’s Materia Medica – Zincum metallicum[9]

Eyes: ‘……Pressure as if pressed into the head. Itching and soreness of lids and inner angles. Ptosis. Rolling of eyes….’

Final remedy

Zincum met.

Posology

Zincum met 200 in plussing mode every 15 min for 7 days.

What is the plussing method and why was it used in this case?

The plussing method is a method of dose administration advocated by Dr. Ramakrishnan, which involves diluting a medicine in water, taking a spoonful of it at regular intervals and stirring it before every dose. This is done to increase the potency of the medicine slightly from its previous dose.[10]

Why plussing? Because it minimises the risk of aggravation and improves the power of the medicinal substance.

Why were LM potencies used?

Initially, the case was started with the CH potency in the plussing method; however, with the CH potency, the risk of aggravation is more when the dose is repeated frequently. This risk is minimised substantially when LM potencies are used. As Dr. Hahnemann writes in the 6th edition of Organon Aphorism 246–247, the medicinal aggravation encountered due to repetition of the medicine can be avoided by the use of his altered and perfected method which he later talks about in detail in Aphorism 270. Thus, he advised giving medicines diluted in water, which can be repeated daily in chronic cases and as frequently as every 10 min in acute cases.

LM6 was selected keeping in mind the rapidity in which the pathology was advancing. Moreover, the patient had strong vitality to withstand a higher LM potency.

Final prescription

December 16, 2019 – Zincum met 200 in plussing mode every 15 min for 7 days

Follow-up and Outcome

Date Follow-up Prescription
2 January Right eye ptosis – Better Rx
2020 Diplopia – Better 25% Zincum met
Restlessness – Better LM 6 – 5 jerks
Control over urine – Better. OD × 2 weeks
Catheter removed. Urgency for
urination at night, has to rush.
Dribbling of urine < night.
Can walk better. Occasionally
loses balance. Now can walk
without support. Trembling of
hands.
Backache – Better
BP – 130/90 mmHg
Weight – 74.3 kg
18 January Diplopia – 0 – Rx
2020 Right eye ptosis – 0 – Zincum met
Vision blurred after looking at LM6 – 5 jerks
one point for more than 2 min OD × 2 weeks
Dribbling of urine <night.
Bladder control – SQ –
Trembling of hands – better
Restlessness – 0 –
BP – 120/80 mmHg ,
Weight – 74.7 kg

Physiological importance of zinc

Zinc is a trace mineral and is necessary for most enzymes to carry out their enzymatic actions. It plays an important role in DNA synthesis, cell growth, protein synthesis, healing damaged tissue and supporting a healthy immune system.[11]

The recommended dietary allowance for adults 19+ years is 11 mg a day for men and 8 mg for women. Pregnancy and lactation require slightly more at 11 mg and 12 mg, respectively.[11]

Sources

Meats, poultry and seafood are rich in zinc. Some plant foods such as legumes and whole grains are also good sources of zinc, but they also contain phytates that can bind to the mineral, lowering its absorption.[11]

Zinc deficiency

Deficiency of zinc can lead to following signs and symptoms:

  • Decreased nerve conduction

  • Neuropsychiatric disorders

  • Neurosensory disorders

  • Mental lethargy

  • Infertility

  • Delayed wound healing.

Zinc toxicity

Excess of zinc can lead to following signs and symptoms:

  • Focal neural deficits

  • Nausea/vomiting

  • Diarrhoea

  • Increased risk of prostate cancer

  • Copper deficiency.

CONCLUSION

This case highlights that homoeopathic intervention at the right time with the right approach can be a successful aid in rapidly progressing diseases. The ptosis – a focal neurological deficit – arising as a sequelae of tubercular meningitis shows the advanced pace of disease and at this point if we are able to help the patient with our rational system of medicine, it speaks of its efficacy and effectiveness. The case also highlights how the use of Boenninghausen’s extended method 7 Ws – The 10 Ws in case taking help to have a complete picture of the patients suffering. The method of dose administration is as important as selection of the right remedy. The use of the plussing method and efficacy of LM potencies is also highlighted through the case.

Declaration of patient consent

Patient’s consent not required as patient’s identity is not disclosed or compromised.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The author(s) confirms 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 the AI.

Financial support and sponsorship

Nil.

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