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Case Report
5 (
1
); 19-23
doi:
10.25259/JISH_45_2021

Treatment of urolithiasis with a homoeopathic constitutional remedy: A case report

Department of Repertory, Dr MPK Homoeopathic Medical College, Hospital & Research Centre, Jaipur, Rajasthan, India
Department of Pharmacy, YPSM Homeopathic Medical College, Alwar, Rajasthan, India
Department of Surgery, YPSM Homoeopathic Medical College and Hospital, Alwar, Rajasthan, India
Corresponding author: Dr. Seema Kumari Meena, Department of Pharmacy, YPSM Homeopathic Medical College, Alwar, Rajasthan, India. seemamamta.jaipur666@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: Thomas S, Meena SK, Mishra C. Treatment of urolithiasis with a homoeopathic constitutional remedy: A case report. J Intgr Stand Homoeopathy 2022;5:19-23.

Abstract

Urolithiasis is a common complaint worldwide; its prevalence has risen considerably in the past few decades. Lifestyle changes and environmental factors are the most probable predisposing factors. Conventional management mostly comprises surgical intervention; however, the condition may recur. Homoeopathic constitutional medicine treats the patient as a whole and prevents recurrence of the symptoms. In the case report presented here, the patient was diagnosed with renal calculi based on ultrasonography reports and was successfully treated with the homoeopathic constitutional medicine (Nux vomica), which was prescribed after careful case taking, thorough analysis, evaluation and repertorisation.

Keywords

Urolithiasis
Homoeopathy
Nux vomica
Modified Naranjo Criteria for Homoeopathy

INTRODUCTION

The term renal calculi are derived from the Latin words renes, meaning kidney and calculi, meaning pebbles. Renal calculi are solid concretions or aggregations of crystals formed in the kidneys from dietary minerals in the urine.[1] The first known evidence of urinary stones was found in a 5000-year-old mummy excavated at El Amrah, Egypt, in 1901. Urolithiasis affects 5–15% of the population worldwide and causes the hospitalisation of approximately 1/1000 Indians. Risk factors such as too many calcium supplements, high urine calcium levels, obesity, certain food habits, certain medicines, lack of fluid intake and hot climate predispose to the condition.[2] Plain radiography of the kidney, ureter and bladder (KUB) region is a valuable diagnostic tool for renal calculi as 90% of calculi are radio-opaque. Ultrasonography is another vital diagnostic tool. Conventional treatment primarily includes surgical intervention. Homoeopathic literature has shown the importance of individualisation in homoeopathic prescription and the efficacy of homoeopathic medicines in eliminating renal calculi.[3,4] In this case, to assess the likelihood of a causal relationship between homoeopathic intervention and clinical outcome, the modified Naranjo criteria for homoeopathy were used as a tool.

CASE REPORT

Patient information

A young male patient aged 25 years visited the outpatient department of Dr M.P.K. Homoeopathic Medical College Hospital & Research Centre, Saipura, Sanganer, Jaipur, on 24 May 2018. He reported a history of aching pain in the left lumbar region for 5 months along with a complaint of unsatisfactory stool 2–3 times in the morning; the stool was of soft consistency without straining.

History of presenting complaints

In July 2017, he had been diagnosed with urolithiasis; according to him, the calculus was expelled after allopathic treatment. Since 5 months, the symptoms of renal calculi had reappeared, including aching pain in the left lumbar region. Allopathic treatments such as painkillers, calcium channel blockers (nifedipine) and a combination of dutasteride and tamsulosin had provided temporary relief. The patient was advised to undergo a surgical procedure. However, he had an intense fear of needles and, therefore, opted for homoeopathic treatment.

Physical generals

The patient was thermally chilly as according to him, he could not bear the cold weather; he frequently develops coryza in the winter. He had decreased thirst but drinks only due to the presenting complaints. Due to his sedentary occupation, sitting for long hours causes excessive flatulence. There was marked perspiration on the scalp and his sleep was unrefreshing with sleepiness in the day. His complaints are aggravated by eating even slightly oily and spicy food.

Mental State

He was anxious about his business (school management) and had a strong fear of needles.

Clinical findings on examination

On palpation, mild pain was felt in the left lumbar region. Abdominal bloating was also observed.

Diagnostic assessment

USG KUB investigation revealed a renal calculus [Figures 1 and 2; dated 17 May 2018 and 4 October 2018, respectively].

Figure 1:: USG KUB (17 May 2018) – Before treatment with evidence of bilateral renal calculi.
Figure 2:: USG KUB (4 October 2018) – After treatment with no renal calculi.

Case analysis [Table 1 ]

The case showed characteristics of general symptoms and was, therefore, analysed using the Kentian approach.

Table 1:: Case analysis and evaluation.
Mental Physical generals Particulars
Anxious about his business+++ Thermal reaction chilly, (frequently develops coryza in winters)+++ Aching pain in the left lumbar region++
Fear of needles++ Thirst decreased but drinks due to presenting complaints Flatulence – prolonged sitting
Perspiration profuse on scalp+++
Unrefreshing sleep++
Sedentary occupation++
General aggravation from spicy and oily food.+++
D2-3, Unsatisfactory stool and soft consistency without straining.++

++ depicts moderate intensity symptoms, +++ depicts severe intensity symptoms

Repertorial totality

  1. MIND – ANXIETY, business, about

  2. MIND – FEAR, pins, of

  3. GENERALS – COLD - take cold, a tendency to

  4. GENERALS – FOOD and DRINKS - drinks-aversion-accompanied by, thirst

  5. HEAD – PERSPIRATION of scalp

  6. GENERALS – FOOD and DRINKS – oil, egg

  7. GENERALS – FOOD and DRINKS – spices, egg

  8. RECTUM – CONSTIPATION, insufficient

  9. SLEEP – UNREFRESHING

  10. BACK PAIN – Lumbar region, left

  11. KIDNEYS – STONES

Repertorial result [Figure 3]

Management plan

  1. Nux vomica was selected as the similimum based on repertorisation as it covers the maximum number of rubrics (8) with the highest marks (18). Nux vomica covers the prominent mentals such as anxiety about business and unrefreshing sleep due to anxiety and physical symptoms such as spices aggravate followed by unsatisfactory bowel habit Natrium muriaticum covered the same number of rubrics but with fewer marks. Materia Medica[7,8] differentiation yielded the fine points that the Nux vomica constitution emphasises a strong sense of duty and strongly values work ethics. The Nux individual is self-reliant rather than dependent, as seen in this patient. Therefore, Nux vomica 30 C was prescribed thrice a day considering the intensity of the symptoms and to avoid any unwanted aggravation[6]

  2. Rhus toxicodendron was used as an acute remedy for the upper respiratory tract infection [Table 2]

  3. Along with the medication, the patient was advised to drink plenty of fluids and adopt a fibre-rich diet with salads for gastric complaints. Decreased sodium consumption was recommended as it increases the possibility of calculi formation. Finally, a regular brisk walk every morning for at least 3–4 km with yoga and meditation was recommended to relieve mental and physical stress.

Figure 3:: Repertorisation of a case with the help of RADAR Version 10.0 using Synthesis Repertory.[5]
Table 2:: Follow-up of the case.
Date Change in symptomatology Prescription Justification
31 May 2018 After the first prescription of Nux Vomica 30/TDS, slight relief observed in general complaints Placebo 30/2 for 14 days Better in general symptoms
14 June 2018 Pain reappeared in bilateral lumbar region after eating oily and spicy food
On examination, tenderness was felt by the patient over bilateral lumbar region but more toward the left side
Nux vomica 30/TDS for 14 days Dietary factors: Oily and spicy food
28 June 2018 Better in general complaints
Lumbar tenderness reduced compared to the previous visit
Placebo 30/2 for 14 days Better in gastric troubles
12 July 2018 Amelioration in general complaints but had diarrhoea on eating spicy foods. General management advised including diet and regime Placebo 30/2 for 28 days Slight improvement; prescribed for 28 days as per the patient’s request as he was out of town due to his business work
09 August 2018 Amelioration in bilateral lumbar region pain. D3-4, loose and unsatisfactory stool. Headache associates whenever excessive flatulence occurred Nux vomica 200/2D (H.S.) weekly followed by placebo 30/2 for 14 days Due to recurrence and to accelerate recovery and establish a cure, the next higher potency was prescribed[6]
23 August 2018 The patient took medicines for 10 days and did not take them for 4 days due to fever and cold
  • Watering of the nose: Discharge is thin and sticky

  • Causation: Getting wet in rain.

  • Blockage of nostrils aggravates after sunset.


Vitals examination – temperature: 99°F; pulse: 90 bpm
Systemic examination: ENT – mild swelling in turbinates and redness around fauces was observed
Rhus tox 200/BD for 3 days followed by placebo 30/3 for consecutive 7 days Causation: Getting wet in rain (Prescribed as an acute remedy for the upper respiratory tract infection)
06 September 2018 Fever and cold reduced
On ENT examination: Swelling of turbinates relieved and redness around fauces disappeared
  • Flatulence in lower abdomen since 3 days ameliorated by passing flatus.

  • Increased thirst (4–5 L in every half an hour)

  • The patient has now become less anxious about his business as explained by himself and his attendant

Nux vomica 200/2D (H.S.) weekly followed by placebo 30/3 for 14 days Toward improvement
20 September 2018 Amelioration in general complaints
USG KUB advised
Placebo 30/3 for 14 days Patient improved and was, therefore, observed
04 October 2018 General amelioration is attained
On examination: No tenderness on abdominal palpation. Bloating relieved. USG KUB: Normal [Figure 3]
Placebo 30/3 for 14 days Relief in symptoms

DISCUSSION

The patient was stressed due to the recurrence of renal calculi. While advised to undergo surgery, he refused due to his significant fear of needles and opted for homoeopathic treatment.

After the case taking was completed, he was reassured that he had made the right choice. The constitutional remedy Nux vomica provided marked relief in his emotional as well physical complaints that is, in general dyscrasia. In this case, Nux vomica was the individualised remedy that was effective in treating the patient with urolithiasis. A case report by Sumithran stated that Nux vomica acts on the circular fibres of the canal of the ureter, which increases the expulsion force and forces out the calculus at once.[3] Moreover, the predisposing factors of a sedentary and busy lifestyle with a tendency to catch a cold and develop gastric disturbances further indicated Nux vomica.

After 4 ½ months of treatment, the patient reported marked improvement in all aspects [Table 2]; this was further confirmed using the modified Naranjo criteria of homoeopathy [Table 3][9] for evaluation. Both the calculi were expelled, as seen on the USG KUB performed on 4 October 2018.

Table 3:: Modified Naranjo Criteria for Homoeopathy.[9]
Domains Yes No Not sure/ NA
1. Was there an improvement in the main symptom or condition for which the homoeopathic medicine was prescribed? +2
2. Did the clinical improvement occur within a plausible timeframe relative to the medicine intake? +1
3. Was there a homoeopathic aggravation of symptoms? 0
4. Did the effect encompass more than the main symptom or condition (i.e., were other symptoms, not related to the main presenting complaint, improved or changed)? +1
5. Did overall well-being improve? (Suggest using a validated scale or mention about changes in physical, emotional and behavioural elements) +1
6A Direction of cure: Did some symptoms improve in the opposite order of the development of symptoms of the disease? 0
6B Direction of cure: Did at least one of the following aspects apply to the order of improvement in symptoms:
  • –from organs of more importance to those of less importance?

  • –from deeper to more superficial aspects of the individual?

  • –from the top downward?

+1
7. Did ‘old symptoms’ (defined as non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement? 0
8. Are there alternative causes (i.e., other than the medicine) that — with a high probability — could have produced the improvement? (Consider the known cause of the disease, other forms of treatment and other clinically relevant interventions) 0
9. Was the health improvement confirmed by any objective evidence? (e.g., investigations and/or clinical examination) +2
10. Did repeat dosing, if conducted, create similar clinical improvement? +1

Total marks obtained = 9/13, which shows that the constitutional remedy Nux vomica got its effective role in treating urolithiasis.

CONCLUSION

Based on this case report, homoeopathy is a safe and effective alternative in cases of surgical conditions like urolithiasis. We also determined that an individualised homoeopathic constitutional remedy prescribed on the basis of totality can be effective in cases of urolithiasis. Research into similar cases is required for further evaluation of the constitutional approach.

Acknowledgment

The authors sincerely thank the patient for opting for homoeopathic treatment, maintaining regular follow-ups and giving consent to publish his case.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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