Diabetic neuropathy and homoeopathic management

Dr Jennifer Lawrence Noronha

ABSTRACT
Diabetic neuropathy refers to various types of nerve damage associated with diabetes mellitus. This article deals with an overview of Diabetic Neuropathy, its classification, symptom’s, general and Homoeopathic management. Various studies were conducted to assess the efficacy of these individualized homoeopathic drugs in this disease.

KEY WORDS- Diabetic Neuropathy, Homoeopathy

INTRODUCTION
There are limitations in the management of Diabetic Distal Symmetric Polyneuropathy in conventional system but in Homoeopathy the research studies have shown positive results.^[1] Symptoms depend on the site of nerve damage and can include motor changes. These changes are thought to result from microvascular injury involving small blood vessels that supply nerves. Over time, high blood glucose levels and high levels of fats, such as triglycerides, in the blood from diabetes can damage nerves.

PATHOGENESIS:
Blood vessels depend on normal nerve function, and nerves depend on adequate blood flow. The first pathological change in the small blood vessels is narrowing of the blood vessels. As the disease progresses, neuronal dysfunction correlates closely with the development of blood vessel abnormalities, such as capillary basement membrane thickening and endothelial hyperplasia, which contribute to diminished oxygen tension and hypoxia. Neuronal ischemia is a well-established characteristic of diabetic neuropathy. ^[3]

DIAGNOSIS:

Diabetic peripheral neuropathy can be diagnosed with a history and physical examination.

1. No reflexes or weak reflexes in the ankle
2. Loss of feeling in the feet (this is checked with a brush-like instrument called a monofilament)
3. Changes in the skin, including dry skin, hair loss, and thick or discoloured nails
4. Loss of the ability to sense movement of your joints (proprioception)
5. Loss of the ability to sense vibration in a tuning fork
6. Loss of the ability to sense heat or cold
7. Drop in blood pressure when you stand up after sitting or lying down.

TESTS THAT MAY BE ORDERED INCLUDE:

• Electromyogram (EMG), a recording of electrical activity in muscles
• Nerve conduction velocity tests (NCV), a recording of the speed at which signals travel along nerves
• Gastric emptying study to check how fast food leaves the stomach and enters the small intestine
• Tilt table study to check if the nervous system is properly controlling blood pressure.^[4]

MANAGEMENT AND TREATMENT

General Management: Keeping your blood sugar as close to your target range as possible is the best way to help prevent or delay nerve damage.

• Follow a healthy diet plan
• Getting regular exercise
• Checking your blood sugar & blood pressure as instructed and keeping a record of your numbers so that you know the types of foods and activities that affect your blood sugar level
• Taking oral or injected medicines as instructed.
• Get regular physical activity.
• Lose weight if you’re overweight.
• Limit or avoid alcohol.
• Stop smoking or don’t start.
• Follow a healthy eating plan.

HOMOEOPATHY IN DIABETIC NEUROPATHY
When diabetic neuropathy is concerned there are many effective medicines available in Homoeopathy, but the selection depends upon the individuality of the patient; ^[5,6.]

KALI PHOSPHORICUM – Homeopathic Medicine for Numbness in Hands and Feet.
Kali Phos is an effective, natural homeopathic medicine for numbness in hands and feet in cases of peripheral neuropathy. Kali Phos also helps in treating prickling sensation in hands and feet. Along with this a general fatigue or weakness is also present. A person needing Kali Phos tends to have a nervous, sensitive and irritable nature. Kali Phos is also indicated for cases of muscle weakness and paralysis.

ARSENIC ALBUM – Homeopathic Remedy for Burning Sensation in Hands/ Feet in Peripheral Neuropathy
Homeopathic medicine Arsenic Album is useful for treating burning sensation in the hands and feet in cases of peripheral neuropathy. The burning sensation may extend to arms and legs. Arsenic Album is also helpful for weakness and heaviness in the limbs in cases of peripheral neuropathy. Apart from the above, a tingling sensation in the fingers is also an indicating feature to use Arsenic Album.

 PICRIC ACID – Natural Homeopathic Medicine for Pin-needle Sensation in Hand/Feet
Picric Acid is a natural homeopathic remedy used to treat a pin-needle like sensation in the hands or feet in cases of peripheral neuropathy. This sensation may be present in legs and arms. A weak, tired feeling in the limbs is also present. Exertion tends to make the complaint worse, and the limbs may get cold.

OXALIC ACID – Natural Homeopathic Treatment for Peripheral Neuropathy Causing Numbness and Tingling in Limbs
Use of natural medicine Oxalic Acid is considered in cases of peripheral neuropathy where there is numbness and tingling in the limbs. Sharp and excruciating pains in the limbs also point towards the use of this medicine.

HYPERICUM – Effective Homeopathic Medicine for Peripheral Neuropathy Due to Nerve Injury
Hypericum is a natural medicine prepared from the fresh plant named Hypericum Perforatum or St. John’s Wort. The natural order of this plant is Hypericaceae. The main indicating features to use Hypericum are numbness, tingling in hands or feet attended with burning pains. A crawling sensation may also be present in the hands and feet in some cases.

CAUSTICUM – Effective Homeopathic Remedy for Muscle Weakness in Peripheral Neuropathy
Causticum is a well-indicated homeopathic cure for treating muscle weakness in cases of peripheral neuropathy. There is marked muscle weakness in the limbs along with a sensation of formication (like ants crawling) in the limbs. Causticum is also used in cases of paralysis.

PLUMBUM MET – Natural Medicine for Thinning of Muscles in Peripheral Neuropathy
Plumbum Met offers a natural cure for peripheral neuropathy in which the patient experiences wasting or thinning of the muscles of the limbs. Paralysis of limbs is also treated well with this medicine.

CADMIUM SULPH: Sensation or feeling of ants crawling in the extremities deep in the muscles. Numbness of limbs. Crawling sensation in paralyzed parts.

CONIUM MACULATUM: Muscular weakness, especially of lower limbs. Fingers and toes numb. Hands weary, heavy, trembling, and unsteady.

HELONIAS DIOICA: Feet feel numb, when sitting. Severe pain in right hip joint, worse during motion. Sore pain in outer side of thigh. Sensation as if cool wind streamed up calves.

PHOSPHORIC ACID: Great weakness and debility of limbs. Pain at night as if bones were scraped. Formication in limbs. Cramps in upper arms and wrists. Numbness along radial nerve. Great sexual weakness.

SULPHUR:  Cold feet in day time with burning soles at night, wants to find a cool place for them, put them out of bed to cool them off. Cramps in calves and soles at night.

REPERTORIAL APPROACH WITH HIGHER GRADED MEDICINES IN VARIOUS REPERTORIES

1. According To Robin Murphy (3^rd Revised Edition) ^[7] Chapter-Clinical (p.- 408) Diabetes, Insipidus – arg., aur., EQUIS., nit-ac., sulph., uran-n.
2. Diabetes, Mellitus–acet ac., adren., ars., BOV., CARC., HELON., LYC., PHOS., PH-AC., PLB., SYZG., TARENT., TER, URAN-N.
3. Diabetes, Neuropathy with –cur., insulin., phos.
4. Diabetes toxic, diabetes – allox., insulin.
5. Diabetes weakness, with – arg., ars., carc., PH-AC., PHOS.
6. Diabetes ulcers, with – insulin.
7. Feet, Tingling sensation, soles – CAUST
8. Feet, Tingling sensation, toes – agar., colch., lach. (p.-746)
9. Feet, Tingling sensation, toes, tips – AM-M., nat-m.
10. Weakness, Diabetes, Mellitus, weakness in – arg., ars., lac-ac., PH-AC., PHOS.

According To Kent (Enriched Indian Edition) ^[8]

• Extremities-Tingling soles in (p.-1209) Caust., nux-v.,rhus tox.
• Extremities, tingling, foot, voluptuous, toes (p. 1210) Toes: Ail., ars., arum-d., berb., cic., colch., con., hell., hep., lach., merc-i-f., merc., nux-m., sabad., sec., stry., verat., vip.
• nails, under: Elaps.
• tips: Acon-c., Am-m., nat-m.
• first: Berb., bufo-s., camph., carb-ac., cic., ran-s.
• second: Crot-t.
• fourth, outer side of: Onos.
• Extremities-Numbness, foot- Arg-n., Ars., Cocc., Con., Graph., Lyco., Ph-ac.,Phos.,(p.-1042)
  Extremities, formication, foot- Agar., Sec. (p.-1008)
• Extremities, formication, Toes, Tips- Amm-m (p-1008)
• Extremities, formication, Soles of: Caust.
• Extremities, numbness, lower limbs- Calc., Graph., Kali-c., Plb., Puls., Tarent.,
• Right – Kali-c.(p.-1040)
  Extremities, numbness, foot – Arg-n., Ars., Cocc., Graph., Lyc., NUx-v., Ph-ac., Phos.,(p. 1042)
• Extremities, numbness, sole of – cocc., (p.-1043)
• Extremities, numbness, Toes: – Graph., Sec.
• Extremities – Pain burning, foot, bed in – Sulph. (p.-1097)
• Extremities – Pain burning, foot, soles: – Calc., Lyc., Sulph.
• Extremities – Pain burning, foot, soles, night: – Cham., Lach., Sulph. (p.-1097)
• Extremities, ulcers, leg: – Ars., Carb-s., Carb-v., Kali-s., Lach., Lyc.,Merc.,Sil., (p. 1222)
• Extremities, ulcers, leg, Burning: –Anthr., Ars., Sil

According To BBCR : ^[5]

• Locomotor system, Lower Extremities-numbness, formication “going sleep” – Agar., Alum., caust., Graph., Phos., Rhus-t.,Sec., Sulph. (p.-826)
• Locomotor system, lower Extremities, Soles, Numbness – Cocc., Lim., Raph., Sep. (p. – 829)
• Locomotor system, Toes, Burning – Alum., Sars. (p. – 830)

Synthesis Repertory: (Synthesis Treasure Edition) ^[9]

• Mind-Dullness, Diabetes in – Helon Op ph-ac sul-ac. (p.-89)
• Mind-Irritability, Diabetes in – Helon Lycps-v (p.-138)
• Urine-Diabetes (see sugar) (p. – 1005)
• Urine-Sugar – Helon., Lyc., Ph-ac., Phos., Plb., Syzyg., Tarent Ter Uran-n (p.-1010)
• Extremities-Swelling, Diabetes in – Arg-m. (p. -1598)
• Extremities-Swelling, foot, Toes – Graph., Sabad. (p.-1603)
• Extremities-Swelling, foot, Toes, Tips – Chin., Mur-ac., thuj.
• Extremities-Gangrene, Diabetic – carb-ac., con., lach., lyc., sec., solid. (p.-1404)
• Extremities-Gangrene, Diabetic, Burning, tearing pain – Sec.
• Generals-blackness of external parts, Diabetic – Ars., Kreos., kres., sec. (p.-1805)
• Generals-weakness, Diabetes mellitus in – acet-ac., Ars., Lac-ac., op., phos. (p. -1967)

RESEARCH EVIDENCE
A multicentric randomised double-blind placebo-controlled clinical trial by Manchanda, Raj Kumar Sharma, Bindu Mehra, Pritha to study efficacy of homoeopathic treatment for diabetic distal symmetric polyneuropathy. Results from this trial help to construct a strategy for treating the patients with DDSP and for improving the quality of life of diabetic patients.^[1]

Another clinical study on management of diabetic peripheral neuropathy with homoeopathic medicine and its evaluation with biothesiometer. The treatment during the study was based on miasm, constitution, and symptomatology including the generals of the patients. So here we can consider them as important in managing Diabetic Neuropathy. The mostly indicated remedy was sulphur 13.3% that is 4 cases out of 30. Then comes the remedies Lycopodium, Belladonna, and Acid Phos which were indicated for 3 cases each. But even though the other remedies were not indicated in so many cases, they played an important role in controlling Diabetic neuropathy of the indicated persons.^[10]

Diabetic Foot Ulcer management by Homoeopathy- A Case Report by Partha Pratim Pal1 & Satarupa Sadhukhan- Kali bichromicum was the remedy of choice. Four doses of 200th centesimal potency, to be taken once daily, were prescribed. Assessment of the ulcer was done using Wagner system and photography of the lesion at the same angle with similar light exposure. By the end of one and half months, the ulcer was found to be healed up. Additionally, it was found that the blood glucose level also dropped down despite there was no modification in the ongoing conventional treatment.^[11]

REFERENCES

1. Manchanda RK, Sharma B, Mehra P. Efficacy of homoeopathic treatment for diabetic distal symmetric polyneuropathy: A multicentric randomised double-blind placebo-controlled clinical trial.
2. Kioskli K, Scott W, Winkley K, Kylakos S, McCracken LM. Psychosocial factors in painful diabetic neuropathy: a systematic review of treatment trials and survey studies. Pain Med. (2019) 20:1756–73. doi: 10.1093/pm/pnz071
3. API Textbook of Medicine YP Munjal
4. The Merck Manual of Medical Information- 2^nd Edition
5. William Boericke; New Manual of Homoeopathic Materia Medica with Repertory; B Jain Publishers, 43^rd Impression,2019.
6. Clark J.H; Dictionary of practical materia medica
7. Robin Murphy; Homoeopathic medical repertory; 3^rd revised Edition;B Jain publishers,2014.
8. J T Kent; Repertory of the Homoeopathic Materia Medica; Enriched Indian edition; B jain Publishers, 9^th Impression, 2002.
9. Frederik Shroyens; The Essential Synthesis; B Jain Publishers, 2007.
10. AJAYAN T, ANANTHAKRISHNAN V. A clinical study on management of diabetic peripheral neuropathy with homoeopathic medicine and its evaluation with biothesiometer.
11. Kumar GN, Chitra V, Gupta P, Biswas B, Arya R. Preclinical updates of the homoeopathic medicines used in diabetes mellitus: A narrative review. Indian Journal of Research in Homoeopathy. 2021 Jan 1;15(1):31.

Dr Jennifer Lawrence Noronha
PG Scholar, Department of Repertory
Father Muller Homoeopathic Medical College
Deralakatte, Mangaluru-575018.