A case of lumbar spondylosis treated with agaricus muscarius

Dr Jayasree V

ABSTRACT
The 43 year old patient complaints of having backache since 4 years. Based on the totality of symptoms AGARICUS MUSCARICUS 200 / 1 Dose was given and it was repeated weekly once for a period of 3 ½ years and the patient feels improved in his complaint.

KEYWORDS :Lumbar spondylosis, Agaricus muscarius

INTRODUCTION
Lumbar spondylosis is a degenerative joint disease that is very common in the elderly. Lumbar spondylosis is due to aging and time-related wear and tear on the vertebrae (bones) of the lower back. The deterioration due to lumbar spondylosis also affects the cartilage, a slippery substance that helps bones to move easily, and the discs, which are pillow-like tissues between the vertebrae that cushion movement of the lower back.

In many cases, there are no symptoms or complications associated with lumbar spondylosis. In some cases the degenerative changes in the lower back due to lumbar spondylosis can lead to compression of the spinal nerves (nerve roots), resulting in lower back pain and pain that radiates to the buttocks and legs. Lumbar spondylosis may also lead to abnormal growths (bone spurs) on the vertebrae, spinal osteoarthritis, chronic pain, and disability.

CASE REPORT

OP.No: 5508/16                                                                           Date: 18/06/2016

Name of patient: Mr. SEKHAR                                                   Age: 43 yrs,    Sex: Male 

 Address: Puthenveedu, Thalayamkottai                                     Occupation: Gold smith

                 Karungal 

PRESENTING COMPLAINTS

LOCATION, EXTENSION & DURATION	SENSATION     & PATHOLOGY	MODALITIES < , >, A/F	ACCOMPANIMENTS
Back Lumbosacral region Since 4 years	Pain	< sitting < raising from seat >lying down <exertion

HISTORY OF PRESENTING COMPLAINTS
The patient complaints of having backache since 4 years. The pain in lumbosacral region started gradually and now the intensity of pain is increased. Taken allopathic medication and he got only temporary relief.

HISTORY OF PAST ILLNESS

• 20 years back- appendiecectomy  done
• 12 years back – typhoid fever-

FAMILY HISTORY

Not relevant 

GENERALS

•  Appetite –  Normal                           
• Stool- Regular
•  Thirst – Normal Urine –Normal
•  Sleep- Normal     Sweat –Normal

REACTION TO

• Desire fanning
• Desire covering
• Desire cold season
• Desire cold food and drinks
• Desire sweet

MENTAL GENERALS

• Desire company
• Easily angered

GENERAL PHYSICAL EXAMINATION 

• Anemia – No Pallor            
• Jaundice – Not icteric                  
• Cyanosis – Nil                                                                    
• Clubbing –Nil                      
• Lymphadenopathy –Nil  
• Oedema – Nil                                                                                       
• Nails – Normal       
• Gait–Steady                                                                                                 
•  Pulse – 72/ min    
•  Resp .rate – 16/ min  
•  Temp – 98.6⁰ F  
•  BP-  120/80mm of Hg

SYSTEMIC EXAMINATION

MUSCULO-SKELETAL SYSTEM

Inspection: No swelling, no discolouration, no scar marks, no deformity 

Palpation:  No tenderness, no local rise of tempertaure

Range of movements: Flexion, extension, lateral flexion are possible but painful

JAPANESE ORTHOPAEDIC ASSOCIATION SCORE FOR LOW BACK PAIN – PRE ASSESSMENT

ITEM	POINTS	SCORE
Subjective symptoms (9 points)
Low back pain	3,2,1,0	3
Leg pain or tingling	3,2,1,0	2
Gait	3,2,1,0	1
Clinical signs (6 points)
Straight-leg-raising test	2,1,0	2
Sensory disturbance	2,1,0	0
Motor disturbance	2,1,0	1
Restriction of activities of daily living  (14 points)
Turning over while lying	2,1,0	1
Standing	2,1,0	2
Washing	2,1,0	2
Leaning forward	2,1,0	2
Sitting ( 1 h)	2,1,0	2
Lifting or holding heavy object	2,1,0	2
Walking	2,1,0	2
Urinary bladder function	0,-3,-6	0

TOTAL SCORE: 22

SEVERITY ASSESSMENT: MILD: Below 13

                                                 MODERATE: 14-20

                                                 SEVERE: Above 20

PROVISIONAL DIAGNOSIS: LUMBAR SPONDYLOSIS ANALYSIS

COMMON SYMPTOMS	UNCOMMON SYMPTOMS
Easily angered Desire cold food and drinks Desire cold season Desire covering Backache < exertion	Desire sweets Desire fanning Backache  < sitting < raising from seat >lying down

EVALUATION OF SYMPTOMS

Mental generals	Physical generals	Particulars
Easily angered	Desire sweets Desire fanning Desire cold food and drinks Desire cold season Desire covering	Backache  < sitting < raising from seat >lying down < exertion

MIASMTIC ANALYSIS

PSORA	SYCOSIS	SYPHILIS
Easily angered Desire covering Backache  < sitting < raising from seat >lying down	Desire cold food and drinks Desire cold season Backache < exertion	Desire cold season

HOMOEOPATHIC DIAGNOSIS: CHRONIC FULLY DEVELOPED MIASMATIC DISEASE – PSORA

TOTALITY OF SYMPTOMS

• Easily angered
• Desire covering
• Desire fanning
• Backache  < sitting
• < raising from seat
• >lying down
• < exertion

REPERTORIAL TOTALITY

REPERTORIAL RESULT

• Agar – 6/3
• Cob – 6/3
• Nat.m – 5/3
• Berb – 6/2
• Rhust. T – 6/2
• Calc – 6/2
• Phos – 6/2
• Puls – 5/2
• Sulph – 5/2
• Arg. N – 4/2

MANAGEMENT: FIRST PRESCRIPTION:  Rx                                                                                                                                       

1. AGARICUS MUSCARIUS 200/ 1 DOSE (M)
2. SAC LAC / 6 DOSES (M x 6 days)
3. B.PILLS 3 x BD
4. B.DISK 1 x BD      x 4 Weeks

ADMINISTRATION OF DOSE: A single globule of no.30 sized medicated globules in 1 grain of sugar of milk is administered orally.

BASIS OF SELECTION OF MEDICINE

• Pain in lumbosacral region
• < exertion
• <rising from seat
• Neuralgia 
• < sitting

FOLLOW UPS

DATE	FOLLOW UPS AND PROGRESS	PRESCRIPTION
22/07/2016	Pain over lumbosacral region feels better than before. Generals – Good BP : 130/80 mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
15/08/2016	Pain in the lumbosacral region feels better than before but persisting slightly < sitting Generals – Good BP : 130/80 mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
14/11/2016	Pain over lumbosacral region feels better than before but persisting. Sweating over whole body and sensation of vertigo present, occasionally. Generals – Good BP : 130/100 mm of Hg	Rx 1.AGARICUS MUSCARIUS
08/02/2017	Pain over lumbosacral region feels better than before. Sweating over whole body persists. < physical exertion < sun exposure Generals – Good BP : 110/90 mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
27/03/2017	Backache slightly better Pain in sacral region < rising from sitting < initial motion Generals: good BP: 140/90mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
21/04/2017	Backache  feels better than before. Sweating over whole body slightly persists but feels better than before.. Generals – Good BP : 128/86 mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
12/06/2017 TO 21/09/2018	Backache  feels better than before. Generals – Good BP : 140/100 mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
31/10/2018	Pain in lumbar region feels better than before Weakness all over body since 2 days Generals – good BP: 150/100 mm of Hg LAB REPORT Haemoglobin : 13.8gm/dl	Rx 1.BAPTISIA TINCTORIA 30
10/12/2018	Pain in lumbar region feels better Generals: Good BP: 130/90 mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
07/01/2019	Pain in lumbar region feels better Generals: Good BP: 124/90 mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
08/02/2019	Pain in shoulder joint, elbow, arm of right hand persists. < exertion Pain in lumbosacral region present < stooping Generals: Sleep: disturbed Other generals: good BP: 140/90 mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
08/03/2019	Lumbar pain better Shoulder pain better Generals: Sleep: disturbed Other generals: good BP: 140/100 mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)                         x 4 weeks
12/04/2019	Lumbar region pain feels better but persists < bike riding Right sided Shoulder joint pain better Generals: Sleep: disturbed Other generals: good BP: 120/80 mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
07/06/2019	Lumbar region pain feels better but persists < bike riding < pressure Pain in shoulder joint better Generals: Sleep: disturbed Other generals: good BP: 130/90 mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
05/07/2019	Lumbar region pain feels better but persists < bike riding  Shoulder joint pain better Generals: Sleep: disturbed Other generals: good BP: 130/80 mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
02/08/2019	Pain in lumbar region feels better than before but persists Pain in shoulder joint feels better Generals: good BP:110/80mm of Hg	Rx 1.AGARICUS MUSCARIUS     200/1 D0SE (M)
26/08/2019	Numbness of both sides of gluteal region < raising from seat < prolonged sitting >walking Lumbar region pain feels better than before Generals: good BP: 116/76mm of Hg	Rx SL
16/10/2019	Numbness in gluteal region feels better than before Lumbar region pain feels better than before Generals: good BP: 110/80mm of Hg	Rx 1.SAC LAC / 7 D0SES
13/11/2019	Numbness on gluteal region better Lumbar region pain feels better  Generals: good BP: 116/70mm of Hg	Rx 1.SAC LAC / 7 D0SES

JAPANESE ORTHOPAEDIC ASSOCIATION SCORE FOR LOW BACK PAIN – POST ASSESSMENT

ITEM	POINTS	SCORE
Subjective symptoms (9 points)
Low back pain	3,2,1,0	1
Leg pain or tingling	3,2,1,0	0
Gait	3,2,1,0	0
Clinical signs (6 points)
Straight-leg-raising test	2,1,0	0
Sensory disturbance	2,1,0	0
Motor disturbance	2,1,0	0
Restriction of activities of daily living  (14 points)
Turning over while lying	2,1,0	0
Standing	2,1,0	0
Washing	2,1,0	0
Leaning forward	2,1,0	0
Sitting ( 1 h)	2,1,0	0
Lifting or holding heavy object	2,1,0	1
Walking	2,1,0	0
Urinary bladder function	0,-3,-6	0

TOTAL SCORE: 2

DISCUSSION: POTENCY SELECTION

 H.A.Robert – Remedy Reaction ⁽⁵⁾ 

The chronic condition causing disturbances to which the remedy is applicable is not of very great depth, it belongs to the functional conditions, exhibiting its effects in the nervous manifestations and the relations of the patient to his surroundings and to tissue changes. These  are the changes in the vital force that are so profound as to cause many symptoms that are very trying to the patient and yet so slight that will all the instruments of precision we don’t observe any pathological changes. It is in these conditions that we sometimes get considerable suffering, yet cures will come without any aggravation. In these cases the single remedy in a moderate potency (say the 200th) will probably complete the work. In such cases we know the potency and the remedy are correct

According to TAPAN CHANDRA MONDAL ⁽⁷⁾
To avoid any danger,it is always advisable to begin with medium potency and cautiously go higher to catch the proper wavelength and critical potency for cure

REPETITION OF DOSE⁽²⁾

§ 248 Fifth Edition
The dose of the same medicine may be repeated several times according to circumstances, but only so long as until either recovery ensues, or the same remedy ceases to do good and the rest of the disease, presenting a different group of symptoms, demands a different homoeopathic remedy

§ 280 Fifth Edition
The incontrovertible axiom of experience is the standard of measurement by which the doses of all homoeopathic medicines, without exception, are to be reduced to such an extent that after their ingestion, they shall excite a scarcely observable homoeopathic aggravation, let the diminution of the dose go ever so far, and appear ever so incredible to the materialistic ideas of ordinary physicians; their idle declamations must  cease before the verdict of unerring experience. 

ACUTE MISHAPS 

• Acute apperance of a new symptom during the chronic course of treatment.
• ie) acute mishappenings 
• It will disturb the treatment only in a temporary way.  – Hahnemann’s Chronic diseases 

FUTURE PLAN OF TREATMENT
After taking AGARICUS 200 in repetited doses, the patient feels improved in his complaint. If the complaint shows relapses, then we can think of an antipsoric remedies in future.

CASE SUMMARY
The patient complaints of having backache since 4 years. Based on the totality of symptoms AGARICUS MUSCARICUS 200 / 1 Dose was given and it was repeated weekly once for a period of 3 ½  years and the patient feels improved in his complaint. In between the course of treatment once an acute mishaps occur for that BAPTISIA 30/ 1 Dose was given and the patient got improvement. The assessment score shows marked improvement in his present state than the initial assessment score. 

REFERENCE

1. Banerjea Kumar Subrata. Miasmatic Prescribing. New Delhi; B. Jain Publishers(p)Ltd;2015
2. Hahnemann Samuel. Organon Of Medicine. Aphorism 5^th and 6^th edition. New Delhi; B Jain     Publishers (P) Ltd; 2005.
3. Boericke William. Pocket Manual of Homoeopathic Materia Medica. AGARICUS MUSCARIUS. Indian books and periodicals publishers (P) Ltd; 2010
4. Schroyens Fredericke. Synthesis repertory 9.1. Radar. New Delhi: Homoeopathic Book Publishers; 2002
5. Roberts.A.Herbert.The Principles and Art of Cure by Homoeopathy  .New Delhi; B Jain Publishers(P) Ltd;2002
6. Dhawale M L.Principles and Practice of Homoeopathy.New Delhi;B Jain Publishers(P) Ltd;2014
7. Mondal Chandra Tapan.Spirit of the Organon. New Delhi;B Jain Publishers(P) Ltd;2004