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Fever is a burning problem in medical practice, more so for Homoeopaths. It is an experience that every homoeopath passes through tremendous psychological pressure of disease condition, patient’s agony and relatives’ anxiety some or other time. ‘Quick Response’ is the demand of time! Main point of worry is hyperpyrexia than the patient or underlying disease process!! Homoeopathy is considered to be a therapy to remove the disease in TOTAL, from its roots, ‘slowly but permanently’ …hence is mainly considered for chronic cases. It has yet to establish its domain for treatment of ‘Acute conditions’ in the society. Convulsions, fever etc. are such conditions, which make others panic. Homoeopath usually gets concession in chronic cases under the pretext that ‘Homoeopathy is slow acting, is long therapy’, and in the bargain homoeopaths gets adequate time to find CORRECT medicine. In acute situations we are really confronted if our judgment is not right. Various aspects of Fever discussed here are based on practical experiences. These experiences are not far from Homoeopathic Principles and Philosophy found in basic books. Most of the time these literature have provided guidelines in critical situations. Can we afford to neglect them under the pretext that they are theoretical? Hopefully the following sharing would be useful to you… Introduction: Fever is a very general term; it is not a disease, only a symptom. It ranges from mild to severe. It may be an expression of acute disease or a chronic one. It is very interesting for us that majority of time core quality of disposition is reflected at time of fever. Homoeopathic Physiology: As thermoregulation represents a delicate balance at level of PNER (Psycho-Neuro-Endocrine-Reticuloendothelial system) axis for the purpose of homeostasis in human being, any disturbance in it expresses sign and symptoms at multiple plane, not only just a variation of temperature of body. This highly supports that fever is not just a symptom, but also a general response to a disease, having expression through over all the human systems. Every sick person responds differently in fever – expression of fever and reaction to fever differs in all; even normal body temperature is highly individualistic. Normal body temperature varies from (oral temp.) 97 F (36 C) to 99.5 F (37.5 C). We are here giving up individualization and are following the mean of statistics i.e. considering 98 F to 98.6 F (36.7 C to 37 C) as a standard! Measuring body temperature as a routine examination of every patient, at least at time of first consultation, esp. at time of febrile state, would surely give a standard to follow in a particular patient. Physiologically, we also know that normal body temperature shows variations due to various factors, e.g.: exertion, emotional, diurnal, environmental, hormonal esp. period of ovulation till menses etc. We as homoeopaths know that every person responds differently to same factors as every person’s propensity is different, their threshold to stimuli is different, their reactivity is different and capacity to adapt to stimulus is different. In the process of thermoregulation, in routine course, such changes occur unnoticed or are neglected, if minor, unless a person is very sensitive; or the balance of thermoregulation has lost its fineness resulting in relatively more intense or prolonged effects. Every homoeopath should go into such details, as this would be an individual response rather than of any disease. Thermal reactions are in that sense relatively ‘crude’ form of responses. Merits of such reactions, esp. when
present, are of differentiating type (different than the general state) needs no further emphasis.
Getting rid of the Routine! In the cases having one of the symptom/ sign as fever, esp. when it is high or in case of children, the first demand comes is to lower the elevated temperature to normal range. Physician’s entire concentration also may shift towards the temptation to prescribe some ‘Fever’ remedy, at least to get rid of fever and then to deal with rest of problems. This is mainly to get rid of tense situation raised within and without. Experiences say that spending time just with Aconite, Belladona, Ferrum phos, Gels., Bry, Rhus tox., Ars. alb, China, China ars/sul, Malaria off, Eucalyptol etc, only considering them as fever remedies to lower the temperature, gives opportunity to inner process of a disease to progress further. We very well know that any drug selected only on the Law of Similia gives the desired result, annihilating the disease in its whole extent (§ 2), rest would just alter symptoms in unhomoeopathic way. Dr. Kent has very well clarified in his ‘Lectures on Hom. Mat. Med, Chapter: Tub. bov.’ – ‘I do not use Tuberc. merely because it is a nosode, or with the idea that generally prevails of using nosodes; that is, a product of the disease for the disease, and the results of the disease… …it prevails and taught that anything relating to syphilis must be treated with Syphilinum; ….it is mere isopathy, and it is an unsound doctrine. It is not the better idea of Homoeopathy. It belongs to a hysterical Homoeopathy… …we may be able to prescribe Tuberc. on the symptoms of Tuberc… …it is antipsoric…’ This clearly states that we must stop prescribing by the name of and for any symptom, pathology, disease or miasms considering something very specific for it. Its demand is that we must understand disease and the disease in each sick individual (§ 3). Underlying disease responsible for fever must be diagnosed, not just nosologically but also define it in terms of its pace and depth in respect to vital parameters. This helps to understand underlying process, depth of pathology, scope of a homoeopath and Homoeopathy, speed at which one need to act in terms of posology, ancillary mode of supportive treatment, hygiene and preventive measures etc. Common about Characteristics: Most of the time diagnostic symptoms are kept aside during inquiry or analysis and lots of time is spared on the details of a person. It means that in order to look for characteristics we go much away from what the patient is suffering from i.e. we keep ourselves busy hunting for something to treat leaving what we are called for! § 3 guides us to perceive disease in each individual case. Primarily we have to find characteristics in what is to be treated and to understand an individual’s response to the disease. Rest of routes requires expertise to get meaningful data to prescribe; otherwise we become prey of our subjective interpretations. For beginners it is easy to investigate at ground level (disease) than abstract (Mind). Characteristics in Common: Hence, rather than neglecting ‘common symptoms’ i.e. diagnostic symptoms of a case, such symptoms should be taken advantage of by tracing them to explore their evolution, presentations, and associations etc. i.e. to find out their individualistic features in the particular patient. These symptoms are the first feelers in tracing characteristics and even immediate associated general symptoms, this is found very useful in cases having fever.
Every patient having same disease with similar set of symptoms will rarely have same evolution as all persons have different inner resources, reactivity, immunity and adaptive capacity. Hence evolution/ anamnesis must be very carefully understood in each case. Like wise all Homoeopathic drugs have different evolution or progress of symptoms. e.g.: Brom, Arum triph, Sep., Lac. can have ascending cold (Boger’s Synoptic Key), where as Phos, Lyc etc are known for descending cold; Gels, Bry (Bry - slowly advancing, forcible process, localising in unyielding tissues, very painful effects - BSK) symptoms are known to evolve slowly unlike Belladona, Aconite, Stramonium etc.; Ars alb shows sudden, intense effects and Phos shows insidious onset, gradually increasing debility, ending in sever or rapid disease; etc are some of the examples, which can be evolved through studying Hom. Mat. Med like Boger’s Synoptic Key, Phatak’s Mat. Med, Kent’s Lectures…etc. In the process of exploring evolution in a case, we reach to the point of apparent origin. This point of origin is most important as it is very much related to exciting factor/s, the apparent state of health and early state of disturbance. Different exciting factors may produce similar effects; same exciting factor stimulates different effects! The key to individualisation lies here as this is one, which is most related to underlying disposition. The target point for every homoeopath to annihilate the disease…(§ 2) On the other side of the point of origin lies the other side of the story i.e. H/o comfortable state, state of well-being. The purpose of treatment is to achieve it i.e. restoration of earlier state of health (§ 1). The early state of disturbance at time of deviation from an apparently healthy state (§ 6) is so much valuable that spotting characteristics in it helps to target the bull (disease) before even identifying it! The symptoms of prodrome have individualistic presentation, which reflects nothing but individual reaction to disease process. Characterising Fever: Homoeopathic therapy is on a far superior pedestal as it ‘can catch the disease young’ through the characteristics symptoms of prodrome. We very well know that symptoms of phases of prodrome and apyrexia present individualistic symptoms. Before the actual disease is known/ establishes, thus, it is possible to abort it. Hence, all the symptoms of both these phases must be well qualified. So many times it needs untiring observation at bedside to get correct picture, mainly of characteristics. Thanks to Dr. Allen, the best reference of this kind is available in his excellent work ‘Therapeutic of Fever’. Its repertory part has exclusively included symptoms of prodrome, apyrexia and changes in general symptoms e.g. desire aversion, etc. Relations of various symptoms of a febrile patient to various stages of fever, interrelation of all the stages with each other, are highly important. It would be worth to quote a case summery of a girl of about 3-4 years of age from my memory. She was in treatment for recurrent allergic asthmatic bronchitis from her infancy. She returned from Ahmdabad and started having fever. Malaria was immediately suspected due to her visit to epidemic area and symptoms. Mother was an excellent observant. She tried to explain bouts of night cough, agony and restlessness of patient during cough. I got a call at around 2 AM in an alarming voice. On visit, I found a panic situation. Mother was unable to sleep/ lie down as the child just wanted to be on lap. Father was trying to pacify the patient. The patient was drowsy with 105 F. She used to get rigors where by cough would <. Fan , lying without covers… P.S. had clearly shown M. P. Pl. Vivex. During attacks of cough the child used to literally jump, be restless, sever spasmodic cough making her bluish - unbearable scene for every member of the family, keeping all awake… This situation demanded a keen observation of the patient, of the surrounding. She was thirstless, tongue was posteriorly coated white. Chest had ronchi all over. The child was a bit dehydrated… This was a peculiar combination of sever bronchitis with malaria. Why did her tendency get activated at this time?
What is the susceptibility of the child? Such association with other concomitants helped me to prescribe Ant. tart. This really brought a good sleep to all and restored her back to normality. Precisely defining symptoms of chill, heat and sweat shows fineness of case taking and grasp of Homoeopathic concepts of disease. Dr. Boenninghausen has very well organised data about this, which Dr. Boger has edited and augmented. This can be used for detailed study and check-list. Concomitants, an ever-dependable aid, are very well grouped in Boger’s Boenninghausen repertory. A patient’s way of looking to illness, his meaning to his suffering helps a lot in individualisation. ‘Next episode of fever would again give breaking pains’ – Fear of pain; suffering during sickness is feared – Fear of suffering; to be down with fever means loss of business/ money/ commitment etc can be referred in business, money, duty related rubrics in Mind chapter. Fever - Hahnemannian Classification: Fever, esp. hyperpyrexia, is looked as ‘acute’ condition, but underlying process defines its type of disease (based on Hahnemannian classification of disease). It may be ‘Periodic’ type or ‘Acute exacerbation’ type of chronic disease. This classification of disease impresses on management – posology and proper interpretation of Remedy reaction. Periodic type is very well mentioned in 6th Ed. Of Organon of medicine, which is well highlighted in ‘Therapeutic of Fever’. In case of acute exacerbation, in between two attacks, patient is not free from signs/ symptoms of the disease, which suggests persistent activity of the disease process (miasm and pathology). Such state needs proper repetition of doses and over all care and timely assessment of case or it would become complex. Fever: Factor of Panic or of Control? Usually fever creates panic, is considered unwanted and is a matter of worry. On the contrary, most of the times, response to fever cases with medicine at general and pathological level confirms right selection, and with such remedy quality of health changes as desired. It is not that fever requires treatment but a process and factors (within and without) responsible for the process requires treatment. Fever, in fact is the most important parameter to judge internal process and response to treatment. If general improvement (peacefulness, improvement in appetite, sleep, bowels etc.) associates with decrease in fever, it strongly suggests that internal activity of disease is coming under control; we must not stop such meaningful signals to assess internal state by just dealing fever by mere antipyretic drugs. It is almost similar to what Dr. Hahnemann strongly suggested against any local applications. Fever: Shooting Up…: It is a frequent experience that patient calls up that after medicines fever has shot up… more worried situation for both, patient’s side and physician’s as well. Correct interpretation is essential for subsequent actions. The possibilities are: No Possibilities Interpretation Action . 1 Patient reported a. The temperature a. Wait, if the remedy is when the initial has to reach to the correct gradually a phase of the disease, ‘Set point’, which general response would fever had just begun. occurred over set and gradually temp. period of time. will lower b. Monitor change in b. -See 2temp. If it continues to increase, it
Temp. is rising
suggests continued activity of disease or Hom. < a. Continued activity of disease if intensity of suffering is increasing with continued state of general suffering b. Hom. <: General improvement with < in local suffering, c. Medicinal <: The drug given may be a partial one, adding its own symptoms. a. Inadequate posology b. Maintaining factors
a. Check the remedy and posology.
b. Wait as the doses must be higher than required, gradually it will show improvement c. Stop treatment, let a fresh picture evolve or revise totality and prescribe indicated remedy
Fever improving for a short while
a. Check Posology and correct b. Remove maintaining factors (Both of the above is helpful provided better at general level) c. Recheck totality and reconsider decide the indicated drug.
c. Drug may be matching at symptoms but not quality.
Remedy response depends upon virulence, reactivity of host, posology and drug reactivity. General improvement at the first instance is the main indication of the correct remedy; we must just follow this guideline. When this response sets in , a patient does not mind having fever as he starts feeling peaceful and confident internally, his interest in surrounding, food, etc improves… Fever: Temptation and Subjectivity Best response is seen when medicine is administered in diluted form (even in centesimal potency), this largely helps in avoiding any undue aggravation. (§ 248 - Footnote 134). Best time to administer medicine is when there is apyrexia, then decreasing temperature, then when it is steady. Medicine given at time of rising state may create confusion about remedy response. If with general improvement next episode (or temp rise at its < time) is higher or milder, WAIT; for next repetition of dose wait for another cycle of episode or < time. In case of confused totality it is most advisable to observe patient for sufficient time till characteristics can be understood, irrespective of temperature, taking co-operation of relatives and a patient; hasty prescription would spoil the case. Recognise internal state that is responsible for the actions: anxiety/ panic, confusion, trials, balanced, over confidence. Never prescribe before taking adequate references, mainly to see what is not covered of the patient by the drug in consideration rather than mere coverage. Hering’s Guiding Symptoms gives various forms of fever in every drug to break our fixed images. Dr Allen has rightly said that majority of cases of fever resemble Ars. alb picture, so control the temptation and be careful to prescribe. One of my regular patients reported in the evening that she had fever since previous night, feeling very weak, no desire to eat, taste was changed, thirst
was increased. I was about to prescribe Ars. alb. I insisted that she must take oral intake, she replied that nothing tastes good, except on the previous night she got up for plums. “For plums?” She answered that usually she never likes plums but on that night when husband asked if she wanted him to get any fruit, she desired for plums! She was also surprised. This was something unexpected. Referring repertory only Sul. acid was found having this desire. Hering’s guiding symptoms helped to understand the picture of fever of Sul acid. On further inquiry Chilliness < indoors, > outdoors, headache > quiet, < draft confirmed Sul acid. This case demonstrates change in general, need to overcome ‘routine’ prescriptions, use of repertory and usefulness of source books. Blocks: Confusion and Limitation It is advisable to lower temperature for time being with minimal doses of antipyretic than a wrong homoeopathic drug, and again to be ready to deal with the case. Any suppressions causes more confusion and more damage, Dr. Allen has beautifully discussed this under ‘Masked Malaria’ and in ‘China sul.’ in ‘Therapeutics of Fever’. Irrational homoeopathic treatment may be more harmful than a rational allopathic treatment. We should be clear about our confusions and limitations; openness for the benefit of patients helps us healing ourselves. Signs never lie: Last but not the least, physical examination and required investigations should not be neglected, Lots of clue like movement of alae nasi, discoloration of cheeks, lips, etc., partial distribution of heat, odor of sweat etc., response to when approached etc and other diagnostic signs would be missed.
“Fever Fever Come Again”: Absence of fever when expected, as part of disease symptoms, is the worst situation – it suggests inadequate reactivity, suppressed immune state – Reaction Poor. We prefer fever than no fever, and fever appearing in such situation after the remedy gives a sigh of relief! Septicaemic fevers also give immediate idea about lowered susceptibility, another alarming signal for prompt action. Fever: Weapon for Self-defense It is observed that fever is beneficial as internally such elevated temperature creates bacterostatic environment restricting disease process in a natural way. If symptoms of past episodes of fever are also supporting the current portrait, it gives confidence about depth of remedy in that particular case. More ever in many cases where picture of the patient is not very clear for prescription, P/H of episode of fever in its clear totality still matching with current state (general/ specific) of the patient, helps to decide the proper remedy. Great God! There is Fever: I recall a case at Shree Mumbadevi Homoeopathic Hospital OPD. A young man in his twenties reported with weakness, loss of appetite and weight. His symptoms were vague, not helping to decide a drug for hom. treatment. On exploring evolution he gave history that he had malaria and since than he was not well. Further inquiry brought out characteristic picture of malaria < mid-night, chilliness, increased thirst, weakness etc. of Ars alb. A dose of Ars. alb set him right; great God! Fever is really a blessing in disguise. Conclusion: Fever is, in fact a defensive response and an important signal of internal disturbance. It is a guide for proper homoeopathic management. It helps us to understand susceptibility and disposition. Fever is not always an acute disease, even if is presenting as an intense disease state or reactivity of the patient. Many
times after confrontation with fever episode, proper remedy of the case is found. Totality of P/H of fever episodes is many times very useful in deciding the remedy. Evolution, prodrome, stages of fever, phase of apyrexia must be explored well to get correct totality. Patience and a keen observation always pays. Fever cases immediately give feedback about physician’s efficiency. It is useful to patient and physician both; it is really a blessing in disguise! Bibliography: a. b. c. d. e. f. g. h. Organon of Medicine, 6th edition: Dr. Sammuel Hahnemann Therapeutics of Fever: Dr. T. F. Allen Synoptic Key of Materia Medica : Dr. C. M. Boger Lectures on Homoeopathic Materia Medica: Dr. J. T. Kent Hering’s Guiding Symptoms Text book of Medical Physiology: Guyton Pathologic Physiology, Mechanisms of Disease: Sodeman – 6th Ed. Principles of Internal Medicine: Harison - XII Ed.
Acknowledgment: a. Smt. C. M. P. Homoeopathic Medical College, Mumbai b. Shree Mumbadevi Homoeopathic Hospital, Mumbai c. Dr. Ashish Nanabhai, Asst. Pof. Department of Human Physiology, Smt. CMP Hom. Medical College, Mumbai. d. Dr. (Miss) Madhavi, Teacher, Case Taking & Repertory Dept., Smt. CMP Hom. Med. College, Mumbai. e. Team members of Homoeopathic Health Care Centers, Mumbai: Dr. (Miss) Aparna Gaikwad, Dr. (Miss) Kishma K., Dr. Ami Shah, Dr. (Mrs.) Mariyam Shaikh.
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