The purpose of this paper is to point out the miasmatic nature (chronic disease) of a condition known as endometriosis and to suggest a possible approach in the homeopathic treatment of endometriosis . It is not intended that this paper present a cured case of endometriosis .
As such a general discussion of endometriosis as regards its nature , aetiology and pathophysiology will be touched upon and a homeopathic interpretation based on miasmatic theory will be offered and a case that responded dramatically to miasmatic prescribing will be presented.
What is endometriosis?
Endometriosis is the growth of cells similar to those that form the inside of the uterus (endometrial cells), but in a location outside of the uterus. Endometrial cells are the same cells that are shed each month during menstruation. The cells of endometriosis attach themselves to tissue outside the uterus and are called endometriosis implants. The implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder, although less commonly than other locations in the pelvis. Rarely, endometriosis implants can occur outside the pelvis, on the liver, in old surgery scars, and even in or around the lung or brain. Endometrial implants are generally benign (not cancerous).1
Characteristics of Endometriosis:
The following are some of the commonest characteristic symptoms of endometriosis. This list is compiled from clinical experience of patients suffering from endometriosis.
· ·.Aggravation of many symptoms in the patients before, during, or after senses.
· ·.Periodicity of 4 weeks, the cycles are frequently shortened to 3 weeks, showing a poor development of the corpus luteal phase of the menstrual cycle and a weak progesterone phase.
· ·.Bleeding, per vaginal discharge, brown, bloody, black, copious watery, color and nature will vary with the phase in the cycle. The watery discharge, gushing and slightly bloody can occur during ovulation.
· ·.Insidious onset, usually in the mid 30’s, a close association with infertility or after long period of not being pregnant.
· ·.Worsens with time and regresses after menopause, regresses during pregnancy and lactation because endometrial tissues regress with the depletion in hormones during menopause and the loss of the cyclical rhythm during pregnancy under hormonal influence.
· ·.Pain may be severe depending on the staging and other factors but coming at 4 week intervals, pain may be felt in the abdomen, supra pubic, back, down thighs ( referred pain ), rectum, etc. depending on the location of the cysts. Dyschaesia, i.e. pain when passing stools especially before during and after menses and dyspareunia i.e. pain during intercourse may be present. These symptoms may be due to the endometriotic lesions in the pouch of Douglas..
· ·.Associated problems include emotional upsets, usually suppressed emotions, digestive problems from dyspepsia to colitis, the mildest being irritable bowel syndrome but may be severe mucous colitis, and adhesion colic.
· ·.Infertility, debilitated state of patient who may not be able to assume daily activities usually two weeks in a month, every month.
· ·.A constant cycle of pain, recovery, a short period of feeling relatively well then a repeat. Body ache and tiredness as well as Inability to cope are frequently associated with this condition when severe.
· ·.Pathological changes are blood cysts in the ovaries, fallopian tubes, adherent to intestines or within the uterus resulting in adhesions, blocked tubes, and its consequences like hydrosalpinx.
· ·.Occasional malignant change.
· ·.Emotional upsets and relationship problems
There are many theories as to why endometriosis happens and the one that I am quite convinced is true is that there is a genetic predisposition to endometriosis and also , it is not a disease of the reproductive organ but is part of a larger disease that involves the immune system .
Genetic studies have shown that endometriosis may have a genetic basis , just like diabetes and hypertension. Studies on a species of monkey that spontaneously develops endometriosis are being done to demonstrate this 2
That the immune system is affected in endometriosis was researched in a survey where the following conclusion was arrived at
“Hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergies and asthma are all significantly more common in women with endometriosis than in women in the general USA population.”3
Most of the diseases mentioned here are related to a defective immune system and to auto antibodies. It is possible that all of it is related to a defective immune system except we do not have all the information about many of these conditions yet .While it is not stated that the hypothyroidism mentioned here is autoimmune , there is autoimmune thyroiditis which is also known as Hashimoto’s Thyroiditis which leads to hypothyroidism
In endometriosis what seems to be happening is that cells that are normally found only in the endometrium of the uterus implant in other places as where they respond to the ovarian hormones in a cyclical manner and bleed when the hormone levels drop as in the normal menstrual cycle.
Two main theories exist for the pathogenesis of endometriosis. One theory is that endometrial tissue is spread by retrograde menstruation or by vascular and/or lymphatic spread. The second theory holds that the serosal epithelium of the peritoneum undergoes metaplastic differentiation into endometrium-like tissue.4
Endometriosis is a chronic disease that has established itself by the time a diagnosis is made ., While I have not been able to find any researcher who links endometriosis to pelvic infections, there is evidence that patients with endometriosis do have infections
Infected Endometriotic Cysts Schmidt et al found pathologic evidence of infection in11of 510 endometriotic cysts(2%). The patients had a mean age of 34.7years and typically presented with fever and lower abdominal pain; about half had a history of pelvic inflammatory disease Histologic examination revealed endometriotic cyst s that contained a fibrino purulent exudate, microabscesses, and inflammatory cells other than neutrophils,such as plasma cells. All of the patients who had one or both fallopian tubes removed at the same operation had histologic evidence of acute and/or chronic salpingitis.5
A Miasmatic theory of Endometriosis
In Webster’s dictionary, the term “miasm” is followed by these meanings: “a vaporous exhalation (as of a marshy region or of a putrescent matter) formerly believed to contain a substance causing disease (as malaria)” “a pervasive influence or atmosphere that tends to deplete or corrupt”. Its Greek root is “miainein” which means “to defile”. “to defile” means “to make something dirty or no longer pure” “to damage something holy or sacred”.
According to Shahrdar,
“From Hahnemann’s writings, it is evident that he also uses the word “miasm” simply to describe an infectious and contagious disease with a specific cause and pattern of growth which can appear in different forms of propagation such as sporadic, endemic or epidemic. In his view, a miasm may be acute or it can be chronic with ever progressing effects on the individual. Speaking in Hahnemann’s language, it should be noted that what is now known as a miasm is actually a chronic miasm”.6
Hence , a chronic miasm is a disease that keeps progressing even when a prescription has been made that covers the presenting symptom for according to Hahnemann, there is a hidden process that needs to be prescribed on and an unmasking of the original symptoms before a miasmatic prescription can take place .
I have made a graphic presentation of what I understand about Hahneman’s Chronic disease theory and to learn more please visit the minutus.org library and study Dr Shahrdar’s writings
.The terms ponos and pathos are from the writings of Hans Selye7 and have been adapted by Shahrdar hence I have placed them in brackets.
Ponos is the acute symptoms as a reaction to the pathogen .
Pathos is Latin for suffering and refers to secondary symptoms as the patient’s body adjusts to a state of incomplete resolution after a pathogen.
Miasmatic remedy refers to the remedies that are chosen based on the combined symptoms of many patients who are affected by a similar pathogen . ( Shahrdar uses the term genus epidemicus)
Dr Shahrdar has proposed that the most important group of pathogens that can cause a chronic state are viruses He has written materia virosum and repertorium virosum that discusses these theories in great lengths and shows how they can be applied to treat cases miasmatically and I will show how it can be applied in the case we will be discussing shortly.8
When a person is infected by a pathogen , there is an acute illnesss ( ponos) which is an acute disturbance caused by the pathogen .. In acute diseases the infection is resolved and the patient returns to the normal optimal state. When this does not take place the patient develops more suffering and the illness becomes chronic ( pathos). Chronic illness is an adaptive state where the health is compromised and the body develops ways to adapt to the compromise in health in order to survive. An example of this happening is when a splinter is in the flesh and the body deals with the splinter at first by suppuration. This is the ponos reaction and then when the splinter still remains , the body acts by depositing fibrous tissue and sending white blood cells to continue attacking the spinter and the person develops a foreign body granuloma and this secondary reaction is the pathos..
In the state of Pathos the disease progresses like what we frequently see in many chronic diseases like rheumatoid arthritis, systemic lupus , diabetes ,and will keep getting more and more complex because of the presence of the unhealed chronic miasmatic state that has been hidden under the pathos .A homeopathic remedy that can heal this person has to address the original unmasked hidden state , that is the original illness hence has to be a miasmatic remedy that is similar to the hidden state and not to the general adaptive symptoms of the patient .To put it in another way,what we see is the secondary adaptive symptoms , the secondary pathological changes and not the hidden disease process that causes these reactions . In order to cure the person , we have to prescribe a remedy similar to the active hidden process We need to unmask the hidden miasm .
A hidden state here means that the VF did not return to normal and remains off balance .
Obviously when something is off balance , the body has to make adjustments to deal with the lack of balance.
You hurt your foot because of walking on a piece of glass and there is a cut on the sole .
Now you walk bearing weight on the other healthy foot .
When a homeopath sees you , he sees the limp but he does not see the cut and injured sole.which remains hidden unless you tell him about the injury and show it to him . If not , it is hidden but still active .
The limp is to compensate for the injured foot and the pain that comes from walking on the injury .
It this situation remains for say 10 days, then more things start to happen .
Because the uninjured foot has had to bear more weight , it is now being strained and , let us say there is an underlying weakness of the hip joint on this side , and now there is a limp , and pain in the hip on the uninjured side .
What needs to be treated is still the cut on the sole because apparently there is still pain caused the whole compensatory way of walking.
All of the compensation is due to the vital force acting in total but the primary state and the whole cause is still the injured foot .
Ok one might say then , since I added that the hip has an inherent weakness that there is actually another state at work here and we would be right .
But , if we tried to deal with this part first, the cure would not work because , the injured foot was what started to make the hip painful and it is still active.
SUMITA: Endometriosis with Primary Infertility
Sumita is a patient of a homeopath in India and I am in Malaysia . I agreed to help him treat Sumita as a consultant and he is the homeopath who took this history . I was consulted because of primary infertility due to endometriosis which was discovered after she was married. She did not get pregnant in the two and a half years of marriage and had undergone both homeopathic as well as allopathic management before I was consulted. She has been diagnosed to be having Endometriosis by ultrasound as well as by Laparoscopy .This is important since a diagnosis of endometriosis by clinical picture or ultrasound alone is not conclusive. Note also the ultrasounds were done intra vaginal which makes them more accurate.
This case was taken at the first interview .Unless indicated as allopathic , all the doctors mentioned refer to qualified homeopathic doctors ( BHMS)
Age: 27 + Married , 2 and half years, No children
Fair , Height 5 ft, Wt 46 Kg, Built Medium
Menstrual Cycle 28 days, Last time flow for 1-2 days. Soreness in lower abdomen with both legs painful. Occasional pain in both ovaries. Occasional Leucorrhea (thick lump).
last menstural period, 2nd June 2007.
History and Background
1. Had a history of severe injury to the head when 7 or 8 years old
2. Had a history of headache from last 10- 12 years agg. from sunlight, Tension, Concentration, long journey. Used to take painkiller (diclofenac .25 mg) to relieve pain.
3. Left sided. pain after sitting for long time in front of Computer (Last 3-4 years)
4. Homeopathy treatment commenced after marriage i.e. Feb 2005 to treat headache. Had B Coli infection on March 2005. After eight months of treatment, started having menstrual pain. Pain used to stay during the periods with fever. However headache reduced subsequently.( under a different homeopath
5. Menstrual Pain did not reduce after continued homeopathic treatment till June 2006. i.e one and half year of homeopathic treatment.
The then homeopath expired in July 2006. He gave the following medicine in chronological order. Arnica 1M 2 doses , Cannabis Sataiva 1M 2 doses (For B coli infection), Tub 1M 2 doses, Bell 2C, Syphillinum 10M 1 dose , Rhus Tox 1m 2 doses, Kali Bich 1M 2 doses, Ant Crud 1M 3 doses, Sulph 30 1 dose Puls 1M 2 doses Calc Phos 1M 8 doses Sabina 30, Colocynth 200, Bovista 200 3 doses ( Note the frequent change of remedies over one month )
6. At the end of July 2006 the menstrual pain became very severe. Pain particularly in left ovary region. USG done in July 2006 and diagnosed as Chocolate cyst in left ovary of size 3.7cm x 3.2 cm. Uterus anteverted.
7. A new doctor was consulted who gave Viburnum Opulus 6 to be taken twice daily. Next period menstrual pain was less but flow lasted for only one day. Patient bed ridden with severe ovarian pain.
8. Another doctor was consulted . He gave Lachesis 30 c,3 doses, repeated 30c3 doses after 10 days and then repeated 200c 2 doses after 14 days. First and second dose was very helpful but 200c had an adverse reaction with severe pain in both ovary. The doctor said the medicine has been overdosed.
9. Was again referred to another doctor in August 2006. He gave Camphor 200 2 doses to neutralize Lachesis and gave Apis 200 three doses. Was better after Apis, than given Pulsatilla CM. Again pain started.
10. Ultrasound scan on September 2006 (2months after first scan) the cyst of left ovary increases to 6 x5.5cm cm and the in the right ovary new chocolate cyst was developed of size 3.2cm. Uterus Bulky. Musculature, Endometrium 6mm Thickness.
11. Allopathic doctor immediately recommended for diagnostic laparoscopy in September 2006. During Laparoscopy the endometrial cyst contents from the right ovary was aspired.
Dye Test : Spillage in both side, Endometriosis and adhesions were found ,
Hysteroscopy showed Uterine Cavity & Cervical canal appeared normal,
Both Ostea Visulised.
Bulky Uterus with endometriosis and adhesions.
12. Given an injection of GNRH 3.75 advised Super Ovulation.
13. Again Homeopathic treatment commenced from November 2006 under the same Doctor . Has given the following medicine in Chronological order
Bacillinium 10m 1 dose with Calc Phos 6x and Ashoka Q, Cimicifuga 1M with Bell Perenis Q and Oophorinum 30c, Calc Phos 200 cwith Bell Perenis Q with Ashoka Q, Bryonia 0/2 with Ustiliago Q.
( a mixture of remedies and repeated over a short period of time )
14. Again undergone ultrasound examination on 23-04-2007. The following findings was found
Uterus is anteverted, normal in shape, size and outline. Myometrial echo pattern is Homogeneous, Cavity is empty. Middline echo is normal. Endometrial thickness is 0.5cm. Cervical canal is normal.
Right adnexal region shows a partly solid and partly cystic space occupying lesion, measuring 5.4 x6.3 cm.
Left adnexal region shows a cystic mass measuring 5.*5.8 cm.
Both the space occupying lesions (SOL) are adherent to the uterus.
Bilateral Ovarian Cyst(Chocolate cyst) Features of Pelvic endometriosis.
· ·.Headache ( much reduced from Homeopathic treatment )
· ·.Occasional Vertigo, Occasional nausea during morning
· ·.Developed Nails yellowish blackish with spoon type shape
· ·.Nerve stimuli (kind of nerve shock) of mainly right leg during sleep. After this leg cannot be straightened for 1 minute. Than the affected leg become sore for 1 -2 days. This has happened 5-7 times in last 2 years.
· ·.Both breast sore agg. before periods amel. after periods.
· ·.Itching eruptions in elbow joint (front side) itching agg. with sweat.
· ·.Piles. Constipation
· ·.Mild pain in ovarian region after urination and stool. Cannot control the urge to stool (entire stomach becomes stiff and movement and standing difficult until and unless stool passes)
Warm Patient, Consolation amel., Sweating ++ under arms and face, Craving for cold food and cold water, Crave for Salty food, Craving for egg but cannot tolerate omelet. Appetite normal. Cold palms occasional
Mild, easily weeps, Fear from shouting quarrel, Religious, Good Natured, Family life comfortable, Irritability before period, Depressed (better after Puls 200)
Migraine of Mother, Diabetes of Maternal Uncle.
Vaccination, Typhoid (Detected in early stage), Injury to head, hand and collar bone.
Another ultrasound was done before she started treatment with me
Here is the report
6 July 2007
Uterus is antiverted, normal in shape, size and outline. Myometrial echo pattern is homogeneous Cavity is empty. Midline echo is normal. Endometrial thickness is .4cm.
Cervical canal is normal.
A thick walled cystic SOL, measuring 2.9 x 5.2 cm another rounded thick walled cystic SOL measuring 3.4cmx4.2 cm. is seen in the Pouch of Douglas.
Both cystic SOL show low level internal echoes.
Bilateral ovarian cyst (?Chocolate cyst).
After discussing with her husband I discovered that Sumita was very sensitive to homeopathic remedies and aggravated a lot after remedies given repeatedly.
Also , since I knew endometriosis had a miasmatic background ,it is to be noted also that any remedy chosen has to match not only the miasmatic background but also aspects of her presenting symptoms ,signs and modalities.
Endometriosis is a sycotic condition because of the nature of the disease which involves the pelvic organs and the sexual organs. it has cysts and fibrosis and these are also sycotic.
Here is a bit about the general naturs of the main miasms
General Nature of the Miasm ( from JH Allen )
A – Psoric Miasm: Itching, burning, inflammation leading to congestion – philosopher, selfish, restless, weak, fears.
B – Sycotic Miasm: Over production, growth like warts, condylomata, fibrous tissue, attacks internal organs, pelvis, and sexual organs. (these are characterostoc of endmetrosis)
C – Syphilitic Miasm: Destructive, disorder everywhere, ulceration, fissures, deformities, ignorance, suicidal, depressed, memory diminished.
D – Tubercular Miasm: Changing symptomology, vague, weakness, shifting in location, depletion, dissatisfaction, lack of tolerance, careless, “problem child”, cravings that are not good for them.
I am quoting an article by Dr Ardavan Shahrdar on miasmatic analysis here
“1.Miasmatic analysis is the process of referring to Genus Epidemicus of infectious states to complete the image which is needed for the selection of simillimum.
2. This type of analysis is actually based on the Hahnemannian definition of miasmatic prescription. In some schools of homeopathy, you may see different miasmatic categories instead of what is here called Genus Epidemicus. Here, the term miasm means infectious disease, as termed by Hahnemann.
3. By ‘infectious diseases’ I am not referring to ‘infectious agents’:. ‘Infectious disease’ is the dynamic state following the stress caused by ” infectious agent”. The infectious “state” can persist without the presence of “‘infectious agent'”
I would like to point out that by Sycosis I mean sycosis according to what Hahneman wrote in chronic diseases and not the sycosis that has been defined by various authors according to their own notions of what sycosis it.
Hahneman refers to sycosis as the fig wart disease and we now know that it is venereal wart which is condyloma acuminatum.
Here is another quote that may bring more clarity to the meaning of sycosis
“Now we clearly know that the figwart part of Sycosis is actually Condyloma acuminatum. HPV, the virus related to condyloma acuminatum, does not cause urethritis and gonorrhea in common terminology. The type of gonorrhea that Hahnemann linked to Sycosis is actually the urethritis caused by Herpes Simplex Virus type 2 (HSV-2) which can occur as co-infection with HPV. That’s why Hahnemann states that figwarts is not always associated with gonorrhea.”9
Hence the sycosis that is meant by Hahnemann is actually a HPV infection that has been complicated by a Herpes Simplex type 2 . This is merely a theory of Shahrdar that I chose to accept in analysing cases and Sumita’s case is one of many that I have successfully treated applying the same theory. The reason for choosing Sumita’s case was that in this particular case the records were complete and I also had a history of her previous remedies which I usually fail to get when patients come to see me from other homeopaths.
Shahrdar has compiled a materia virosa in which he has collected from various sources the pathology that is produced by various viruses and below you see how Sumita’s symptoms correspond to the HSV2 viral state and the HPV viral state . Note that I am not saying she has these two infections, only the viral state which Hahneman named miasm. JH Allen in his book Chronic Miasms and Pseudopsora clearly stated that the sycotic miasm affected the pelvic organs as we see in cases of endometriosis in general and in Sumita’s case in particular.
Hahnemann differentiates sycotic gonorrhoea from what he called the common gonorrhoea .A careful reading of his description of the initial stages of Sycosis in his book Chronic diseases will show that he distinguishes simple gonorrhea from the more compels gonorrhoea of sycosis .10
“The gonorrhoea dependent on the figwart-miasma, as well as the above-mentioned excrescences (i.e., the whole sycosis), are cured most surely and most thoroughly through the internal use of Thuja,* which, in this case, is Homoeopathic, in a dose of a few pillets as large as poppy seeds, moistened with the dilution potentized to the decillionth degree, and when these have exhausted their action after fifteen, twenty, thirty, forty days, alternating with just as small a dose of nitric acid, diluted to the decillionth degree, which must be allowed to act as long a time, in order to remove the gonorrhoea and the excrescences; i.e., the whole sycosis. It is not necessary to use any external application, except in the most inveterate and difficult cases, when the larger figwarts may be moistened. every day with the mild, pure juice pressed from the green leaves of Thuja, mixed with an equal quantity of alcohol”chronic diseases page 84
Below is a repertorization to search for viral states using repetorium virosum
This is a repertorium virosum analysis of Sumita’s symptoms. Note that the rubrics chosen are
Buttock Pain shooting
The reason for the brevity and seemingly general symptoms are because of the way the materia virosa is recorded , it is all just clinical symptoms and very brief.
The other limitation of materia virosa is that it does not record secondary symptoms , for example there is no entry on dysmenorrhea or endometriosis . The only entry on endometrium is endometritis which is an acute state and not related to endometriosis , it would however be related to fibroid uterus which is actually a culmination of chronic inflammation. which we later found out Sumita had .
In this the RV has many limitations
1. few and brief symptoms
2. most secondary symptoms are not in it , and have to be deduced .
In spite of these limitations , in the hands of a person who can translate secondary symptoms back to their primary symptoms , the software is a great tool for deducing the viral state that is still active .Please note that viral state is another name for viral miasm which can be said to be a subgroup of the original miasms of Hahnemann.
In this analysis the virus that has all the rubrics is HSV2 .
HPV has only one rubric but knowing the Human Papiloma virus’s affinity to the pelvic mucous membrane as well as it being implicated in Hahnemann’s original sycotic miasm , I am inclined to think that this is a miasm that at the moment is not dormant but present.
Below are the materia virosa of the two viral states that I mentioned above .
Papilloma viruses/Human Papilloma Virus (HPV) Main Regions
Skin, Male organs, Female organs, Mind, Extremities, Larynx, Respiration. Modalities
Aggravations: Night. Mind
Sadness. Taciturnity. Loathing at life. Dullness. Anger. Irritability.
Crusty eruptions. Occipital pressing pain. Eye
Conjunctivitis. Pressing pain. Vision
Dim vision Nose
Catarrh. Yellow discharge. Mouth
Mucous. Pain on swallowing.
Increased appetite. Eructations.
Distention and rumbling. Cramping pains.
Rectum Hemorrhoids. Burning pain after stool.
Burning pain during urination.
Altered cry in children. Hoarseness.
Cervical cancer. Maculopapular eruptions. Warts.
Male organs Maculopapular eruptions. Warts. Increased sexual desire.
Warts. Painful plantar warts. Itching of lower limbs. Weakness of knee.
Stiffness in cervical region.
Sleep Sleeplessness. Falling asleep late.
Skin Warts. Painful warts.
Weakness. Lack of vital heat. Burning pains. Stitching pains. Yellow discharges. Aggravation at nights.
Antimiasmatic remedies THUJ, NIT-AC, CALC, LYC, Nat-s, Staph, Sabin, Sars.
Herpes Simplex Virus 2 (HSV-2)
Skin. Genital organs. Rectum. Extremities. Chest. Eye. Head. Mind. Urinary system.
Irritability. Anger, Excitement, Dullness, Weakness of memory.
Encephalitis. Meningitis aseptic. Headache pressing, stichting. Frontal headache. Occipital pressing headache. Headache aggravated by stooping. Crusty eruptions on head. Moist eruptions. Falling of hair. Heaviness.
Herpetic eruptions. Heat.
Chemosis. Retinitis. Ophthalmitis. Chorioretinitis. Conjunctivitis pustular. Dendritic lesions of cornea. Keratitis. Retinal necrosis. Pain burning, pressing, stitching. Photophobia. Blepharitis.
Blindness. Blurred. Dim.
Catarrh. Coryza. Purulent discharge. Dryness inside nose. Internal sore pain. Scurfy nostrils.
Gingivitis. Stomatitis. Ulceration. Ulceration of tongue.
Exudation. Pharyngitis. Tonsillitis. Ulceration. Stitching pain.
Diminished appetite. Increased appetite. Nausea. Vomiting. Eructations. Pain pressing.
Hepatitis. Distention. Rumbling. Cramping pain.
Tender lymphadenopathy. Herpetic eruptions.
Constipation. Diarrhea. Discharge. Necrosis. Pain burning, after stool. Proctitis. Tenesmus. Ulceration. Excoriation. Weakness of anal sphincter. Hemorrhoids. Hemorrhage. Itching.
Enlarged bladder. Enuresis.
Dysuria. Frequency. Retention. Cloudy.
Hoarseness of voice
Vesicular eruptions. Axillary lymphadenopathy. Substernal pain. Interstitial pneumonia. Pneumonitis. Irritation in trachea. Oppression. Stitching pain.
Endometritis. Herpetic eruptions. Pustular eruptions. Vesicles. Salpingitis. Ulcers. Inflammation. Excoriation. Itching. Leukorrhea. Menorrhagia.
Herpetic eruptions. Impotency. Prostatitis.
Arthritis monoarticular. Edema of fingers. Herperic eruptions on thighs. Pustular eruptions on fingers. Vesicular eruptions fingers. Erythema of fingers. Tenderness of fingers. Shooting pains. Tingling. Herperic whitlow. Coldness and perspiration of feet and hands. Cracking in joints. Heaviness of lower limbs. Itching of lower limbs. Stitching pain in knees. Right side.
Stiffness of cervical region. Anesthesia or hyperesthesia of lower back and sacral region.
Herpertic eruptions. Shooting pain. Tingling.
Falling asleep late.
Eruptions. Erythema multiforme. Herpetic eruptions. Tubercles. Boils. Ulcers. Itching.
Anorexia. Hemorrhage. Hyperesthesia. Hypothermia. Lymphadenitis. Malaise. Myalgia. Myelitis transverse. Radiculopathy. Sepsis. Weight loss. Thrombocytopenia. Dryness of mucous membranes. Weakness. Emaciation. Ulceration. Excoriation. Stitching pains.
MERC, Nat-m, Petr, Nit-ac, Calc, Thuj.
From the above note the genus epidemicus ( miasmatic ) remedies for HPV are:
THUJ, NIT-AC, CALC, LYC, Nat-s, Staph, Sabin, Sars.
And the genus epidemicus ( miasmatic ) remedies for HSV2 are :
MERC, Nat-m, Petr, Nit-ac, Calc, Thuj.
Below is a repetorizing using Hompath Classic version 8 .
Hompath Rubrics were taken from almost all of the symptoms she was having at that point.These are the rubrics that I chose . The reason I chose them is because they are the symptoms of the underlying miasm which is active at that point in time .. I had included some general symptoms but ignored her pain after stools because it is a secondary symptom caused by adhesions due to endometrial lesions in her peritoneal cavity which means they are of no use in pointing to the underlying miasm in that they are secondary symptoms . You will find some of thse symptoms in the HSV2 of the materia virosum which means they belong to the Viral State of Herpes Type 2.
1. Rectum haemorrhoids.
2. Head Pain headache in general sore bruised sensitive to pressure
3. Female genitalia pain general
4. Extremities Cramps leg Calf Night
6. Breast sore before menses
7 Food and drinks Salt desires
8 Extremities Nails discoloration
Here is the repertorization
The top 5 remedies are Nitric Acid , Sulphur, Calc Lyc, Phos .The only remedy with all the rubrics is Nitric Acid .. This is also the remedy present in Shahrdar’s materia virosum list for both HSV2 and HPV.
The remedy that seemed to be the closest similimum for Sumita in both her total self as well as the viral state ( miasm ) that was present is NITRIC ACID .
I had instructed Sumita to take Nitric Acid 200c in water . The reason being that I knew she was sensitive . Some may want to know why I did not use LM .I do use LM but in this case I wanted to use the 200c potency . Homeopathy as many of us know is not such an exact science of knowing exactly what and how to give a remedy and many of us will just make a decision and change the decision or not based on the results obtained .
Here is a report after this first 3 doses , actually a split liquid dose since a few drops of tincture was place in 60 ml of water and the remedy given in three doses, shaking the bottle before each dose .
The medicine Acid Nitric 200c ;was given one dose on;9.07.2007 and another; two doses on 10. 07.2007.I am writing down the symptoms on chronological manner
Slight pain in both ovary,feeling very hot
– Vertigo (a kind of crawling pain in the head), feeling very drowsy, had mild temperature 99 deg F
– No fever
-,Vertigo or crawling pain agg morning, afternoon and night
– Constipation and Vertigo or crawling pain head.
-Hard stool followed by normal stool, again diarrhoea three times also vertigo or crawling pain in the head.
– once semi solid stool, stomach rumbling, left hip portion
feel stiff feeling discomfort while breathing, slight discomfort in ovarian region while walking and breathing and sitting.
She says that there there is something moving along the nerves in the head. when stooping eyes get closed.
reported on 15 Jul 2007
After this report I asked to wait before any further dosing , and here is the next report Note the ultrasound findings.
Medicine taken: Acid Nitric 2C on 9th and 10th July 2007
Aggravation for 10 to 12 days including leg pain, headache, fever, diarrhea
LMP: 26th July 2007
Flow after 26 days of last period (usually 28) (Last period 30.06.07)
Just before flow she had gone four times to stool. Stool was in adequate quantity, which aggravated the fissure and piles.
Heaviness of the lower abdomen before period and continued for first two days.
Slight pain in ovary during period. Normal flow
Before period irritation, tension and weakness.
Before 4 to 5 days of period (21 and 22 July), there was both leg pain and hand pain (shoulder to finger tip)
Flow lasted for 2 days
On 4th and fifth day there was diarrhea.
Breast soreness is always present but very less earlier aggravation was before period.
Heaviness of the head with headaches (slight), which seems to come from top and move downwards to forehead(last two days)
When getting up there is a slight sensation (Like air lock) in the right ovarian region.
When urinating urine feels as if it is flowing out of lower abdomen.
For last two days there is vomiting tendency agg. on seeing food and smell of vegetable.(Now less)
Nails dotted/flattened still present.
Itching eruption in the front portion of both elbows had reduced but now it more agg. Form water & sweat. Seems to spread in area.
Abdominal gas present.
Rectal fissure is not there but piles present (which comes out and moves in).
Now can control urge to stool. But slight discomfort present. (Lower abdomen becomes stiff –as if filled with gas on urge to stool)
No cough and cold.
Sweat in underarms.
There is a slight soreness in the lower abdomen, which can be felt on breathing.
Ultra sound report ( Intra Vaginal Probe) Report done on 2.08.2007
Uterus is normal in size, cavities free.
Rt. side ovary there is a organized cyst of 2.98 cm by 2.76 cm
Lt side ovary there is cyst of 2.45 by 2.22 cm.
Pouch of Douglas is free
It was obvious that her endometriosis was on the retreat. The cysts were smaller and the lesions in the pouch of Douglas had disappeared .
She was given a repeat split dose of Nitric Acid 200c again on 13-15 August 2008 and she subsequently became amenorrheic and was tested to be pregnant.
Here is a tabular record of her progress.
Date of Med
8th June 2007
After Puls 200c ( By Another Doctor
Symptom date: 28thJune 2007
Cyst Size measuring Right 2.9 x5.2 cm left 5.9×4.8cm another rounded thick walled cystic SOL measuring 3.4 x 4.2 cm. is seen in the Pouch of Douglas. Headache present agg on Journey and tension and from sunlight. Pain in ovarian region during/after urination and stool. Kind of Nerve shock of mainly right leg during sleep. After this leg cannot be straightened for 1 minute affected leg become sore for 1 –2 days. Could not control the urge to stool, as there was much stiffness of the lower abdomen.
Menses Last for 1-2 days. During Menses soreness in lower abdomen with both leg pain. Occasional pain in both ovaries during menses.
Nails infection. Itching eruptions on anterior portion of both hinge joints of hands. Headache present.
Constipation, piles with rectal fissure present.
There was pain after stool.
The vaginal ultrasound showed the lesion progressing now to pouch of Douglas
9th July 07
After Ac Nit 200c (60 ml , 1/3, 1/3, 1/3)
Rt Side Ovary there is a organized cyst of 2.98 cm by 2.76 cm Lt side Ovary there is a cyst of 2.45 by 2.22 cm. POD is free. Improvement in head ache. Pain in ovarian region after urination and stool was not there but reappeared in last three days. Nerve shock happened once during period on awaking.. Happened again on 10.08.07. Can control urge to stool but slight discomfort present. Heaviness of lower abdomen before period and continued for first two days. Flow lasted for 2days. Third day there was a slight flow. Normal Flow. Just before flow she had four times stool, which aggravated her fissure and piles. Nails infection same. Itching eruptions on left elbow joint same, not much itching.Right elbow joint itche seems to increase in area with more itching. No rectal fissure.Piles is present
She aggravated for 12 days after this dose.
Many symptoms improved but started to reappear hence I asked her to repeat the dose after this report .
13th August 07
After Ac Nit 200c (180 ml , 1/3, 1/3, 1/3)
Sonography not done. No Headache but a kind of heaviness (crawling sensation) is there particularly when awakening. Pain in ovarian region after urination and stool was not there. Nerve shock of the legs did not occur. Can control urge to stool. Flow last for 2-3 days.1st day was very little (few drops). 2nd day watery flow. 3rd day was in clot (slimy thread like). No heaviness but on 2nd & 3rd day mild pain in lower abdomen. Nails infection same. Itching eruption of Left side has reduced in area but right side has increased in area with more itching. Constipation and rectal fissure is not there. Piles present . NEW Symptoms Teeth infection.
Her headache went away entirely, so did ovarian pain after urine and stools as well as the nerve shock . The dysmenorrhea was markedly reduced .She developed a tooth ache which went away shortly ..
This was her last menstrual period .
The nail has improved !
When I got this report we already knew she was pregnant . The pregnancy explains why some of her symptoms came back and she developed new symptoms probably due to adhesions from the endometriosis which had not had time to resolve.
The diagram above shows the ultrasound changes before and after treatment . There was only one ultrasound report after she took the miasmatic remedy and she subsequently got pregnant.
It may be argued that she may have got pregnant without the miasmatic treatment but if you compare her progress in terms of symptoms which corresponded to the cysts disappearing from the pouch of Douglas then it is highly probable she became pregnant because the cysts regressed .
Note also the improvement in her nails as well as her general symptoms of headache and vertigo .
It would also be too much of a coincidence that she got pregnant after miasmatic treatment if it had not been curative to her infertility because she had been married two and a half years without conceiving .prior to miasmatic treatment.
No doubt at this point she still needed homeopathic treatment . She had become pregnant too early after the miasmatic treatment started and she still had adhesions in her abdomen from the endometriosis , also , while we did not know it at that time, she had small fibromas in her uterus that caused the placenta to implant in her lower uterus and hence the delivery was by caesarean section. The fibromas were discovered during the C section. I continued to prescribe homeopathic remedies through out her pregnancy and she managed to have a drug free pregnancy even though she had some discomfort due to the adhesions and the growing pregnancy.
Sumita gave birth to a healthy baby boy and is currently breastfeeding the baby which she delivered by caesarean section on 11.05.08. I am continuing to record her progress and no doubt will have more to report when she starts to menstruate again and we can make an assessment of her reproductive system .
I have not reported on her ongoing treatment and will do so when the case is complete.
Sumita had been under the care of homeopaths for a very long time before I took over . What was not done in her treatment was to look into the miasmatic nature of her disease and to prescribe accordingly. While treating her for headache earlier , even though the headache reduced, her menses became more and more painful and , as we saw later, her endometriosis became progressively more severe with more and more lesions found on subsequent ultrasound scans.
This is consistent with Samuel Hahnemanns observation of Chronic Disease
“It was a continually repeated fact that the non-venereal chronic diseases, after being time and again removed homoeopathically by the remedies fully proved up to the present time, always returned in a more or less varied form and with new symptoms, or reappeared annually with an increase of complaints. This fact gave me the first clew that the Homoeopathic physician with such a chronic (non-venereal) case, yea in all cases of (non-venereal) chronic disease, has not only to combat the disease presented before his eyes, and must not view and treat it as if it were a well-defined disease, to be speedily and permanently destroyed and healed by ordinary homoeopathic remedies but that he has always to encounter only some separate fragment of a more deep-seated original disease”Samuel 11
I decided upon Nitric Acid based on the repertorizing and elimination from the lists of the Materia Virosa for the HSV2 state and the HPV state and from the dramatic response in which the cysts regressed and she subsequently became pregnant , it was a near perfect similimum to the miasm behind the disease. An aspect of the patient that was not addressed by the other homeopaths was her sensitivity to remedies. She only needed two doses of the remedy given in water as a split dose . She did not need multiple remedies either.
To take this one step further if we chose to accept Shahrdar’s viral miasms .Her symptoms are those of a viral state or a viral miasm. Sumita is having the HSV 2 viral state and possibly the HPV state although this does not come out very well in the RV analysis. .It is to be noted that at any one time , one state will dominate and be uppermost that the other state will manifest when one state is cured by a similumum remedy. This is consistent with what Hahneman points out in Chronic diseases . At this point in the treatment I have not presented enough data to demonstrate this .
In my practice , Endometriosis has become a treatable disease and with the application of the Miasmatic theory and prescribing accordingly , the disease is not just palliated but cure is possible .It is my conviction that one day the medical profession via research will validate what Dr Shahrdar12 has theorised, that viral infections cause miasms in the body. 13
It is now May 2009 and almost 2 years since I started treatment in July 2007. Sumita has pain free periods now . Her treatment is still under my supervision and she is still having symptoms of chronic miasmatic states but they are no longer endometriosis symptoms
Endometriosis , the homeopathic management , Suriya Osman IBPS publications,
Chronic Diseases , Samuel Hahnemann
Mary Lou Ballweg Endometriosis Source Book Published 1995
McGraw-Hill Professional ISBN:0809232634
contact the author at
1Melissa Conrad Stöppler, MD Endometriosis http://www.medicinenet.com/endometriosis/article.htm
2Krina Zondervana, Ion Cardona, Ronald Desrosiersb, Dallas Hydec, Joseph Kemnitzd, Keith Mansfieldb, Jeff Robertsc, Joan Schefflerd, Daniel E.Weekse and Stephen Kennedy The Genetic Epidemiology of Spontaneous Endometriosis in the Rhesus Monkey Annals of the New York Academy of Sciences 955:233-238 (2002)
3Cleary, S. D. 2; Ballweg, M. L. 3; Nieman, L. K. 1; Stratton, Ninet Sinaii , High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Human Reproduction. 17 No (10): pages 2715-2724, October 2002
4Shawn Daly, MD,,Eric Outwater, MD, Endometrioma/Endometriosis Aug 16, 2007 http://www.emedicine.com/radio/topic250.htm
5Schmidt CL, Demopoulos RI,WeissG. Infected endometriotic Int JGynecol Pathol. 2002;22:8388. 1981;36:2730
7 Hans Selye The Stress of Life Published 1984 McGraw-Hill reference to ponos page 3
9Ardavan Shahrdar., Sycosis and Gonorrhoea http://minutus.org/library/article_read.asp?id=16
10Samuel Hahnemenn Published 1999 B. Jain PublishersA footnote of page 84 of Chronic diseases tells about common gonorrhoea
11Samuel Hahnemann Chronic Diseases Published 1999 B. Jain Publishers