Role of Thuja as an intercurrent remedy in Osteoarthritis

Dr Jenifer Antoni Dayana J

A 46 year old female patient presented with complaints of pricking pain both knee joints especially pain extending to right knee joint to thigh and to ankle joint since 1 1/2 years, and also she had the complaints of cervical region pain with numbness and the pain extending up to left elbow joint 10 years .She was treated with RHUSTOX 1M along with an Intercurrent remedy THUJA with which there is gradual improvement of the symptoms as well as the health condition of the patient.

PRESENTING COMPLAINTS:

LOCATION	SENSATION	MODALITIES	ACCOMPANIMENTS
Lower Extremity Both knee joints especially right extending up to down right ankle joint Since 1 ½ years Cervical region extending to left elbow  joint Since 1 year	Pricking pain with numbness pain with numbness	< initial motion < raising from seat < walking < lying on affected side < stooping < turning the head < flexion	Pain in both heels Pain in right arm

H/o Present illness :The patient complaints of pricking pain in both knee joints with numbness since 1 ½ yrs. The patient also has pain in both heels and also pain in right arm. The patient also suffers from pain in cervical region with numbness since 1 year. The patient took allopathic treatment but got only temporary relief. 

HISTORY OF PREVIOUS ILLNESS WITH TREATMENT ADAPTED :

AT – 24yrs – Typhoid – Allopathy – Relieved 

GENERAL FEATURES :

Mental generals:

• Worries about his son’s health 
• Desire Company 
• Calm

Physical generals :

       Appetite: Good                        Stool: Regular

       Thirst: Normal                        Urine: Normal

       Sleep: Normal                         Sweat: Increased over neck and abdomen

Reaction to : 

• Desire winter season
• Desire fanning, 

Physical findings:

Anemia: No pallor                     Clubbing: Nil

Jaundice: Not icteric Nil            Edema: Nil

Cyanosis: Nil                             Lymphadenopathy: Nil

BP: 120/70 mm/Hg                   Temperature: 98.6⁰F

Pulse rate: 68/min                     Respiratory rate: 16/min

Ht: 154cm                               Wt: 57 Kg              BMI: 24.2Kg/m 2

MENSTRUAL HISTORY:

FMP: 14yrs                        Menopause: 45yrs

OBSTETRICAL HISTORY:

_{G2 P2 D0 A0 L2}

SYSTEMIC EXAMINATION:

                                   Inspection: No scar, no discoloration, no swelling. 

                                   Palpation:  Crepitus felt on left knee joint 

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

                                   Gait steady                                                    Appearance           Movements

                                                                                            Arms            **                           **

                                                                                            Legs              **                           X

                                                                                            Spine             **                           **

ANALYSIS OF SYMPTOMS :

COMMON SYMPTOM	UN COMMON SYMPTOM
Pain in knee joints < walking Pain in cervical region  < stooping < turning the head < flexion	Pricking pain in right knee joint Numbness < initial motion < raising from seat++ > lying on affected side Pain in cervical region extending to left elbow joint  Worried about son’s health Desire winter season

EVALUATION OF SYMPTOMS :

Mental generals:

• Worries about his son’s health 
• Desire Company 
• Calm

Physical generals:

• Desire winter season
• Desire fanning, 

Particular Symptoms:

Pricking pain with numbness in knee joints

• < initial motion
• < raising from seat
• < walking
• > lying on affected side

Pain with numbness in cervical region

• <stooping
• <turning the head
• <flexion

Totality of symptom:

Worries about his son’s health 

Desire Company 

Calm

Desire winter season

Desire fanning, 

Pricking pain with numbness in knee joints

< initial motion

< raising from seat

< walking

> lying on affected side

Pain with numbness in cervical region

< stooping

< turning the head

< flexion

MIASMATIC ANALYSIS :

PSORA	SYCOTIC	SYPHHILLIS
Pricking pain Numbness Worries Sweat increased	Joint pain (knee) Numbness < movement < walking	< movement

CHRONIC FULLY DEVELOPED MIASMATIC DISEASE OF PSORA- SYCOTIC.

PROVISIONAL DIAGNOSIS:  OSTEOARTHRITIS OF BOTH KNEE JOINTS

MEDICINE SELECTED:  

ON FIRST VISIT:  RHUSTOX 

BASIS OF SELECTION:

• Affections of fibrous tissue
• Markedly joints and tendon 
• Pain and stiffness
• Right sided affection 
• < First motion after rest
• < On getting up in the morning
• Pain in both heels

ON SECOND VISIT: THUJA, RHUSTOX

BASIS OF SELECTION:

• Anxious (worried about son’s health)
• Rheumatism with numb feeling
• < On moving
• Pain knee joints
• Pain in both heels

METHODS ADAPTED:

FIRST PRESCRIPTION:  13.04.2018
                           1. RHUSTOX 1M / 15 DOSES (HS) (No .30 sized 1 medicated globule in 1 grain of sugar of milk – dry dose  (HS X 15 Days)

                           2. B.PILLS 3 X TDS

                           3. B.DISC 1 X BD 

                                               X 2 WEEKS 

MODE OF ADMINISTRATION OF MEDICINE: One 30 sized medicated globule in one grain of sugar of milk –dry dose is advised  to be taken orally every night for15 days .

ON SECOND VISIT: 27.04.2019

     Rx

              1. THUJA 1M /1DOSE (HS) (One 30 sized medicated globule in one grain of sugar of   milk –dry dose HS X 1 Day) 

   2. RHUSTOX 1M /14DOSES /1DOSE in 10ml aqua QDS(,( no .30 sized 1 medicated  globule in 10 ml aqua 10 drops  4 times per  day X 14 Days ) 

             3. B.PILLS 3X TDS

            4 .B.DISC 1XBD 

                               X 2WEEKS 

BASIS OF SELECTION OF POTENCY:

Potency is selected according to the susceptibility of the patient. 

CRITERIA	HIGH	MODERATE	LOW
AGE		2
SEX		2
SEVERITY OF DISEASE	3
SLEEP	3
OCCUPATION		2
PREVIOUS TREATMENT	3
SIMILIMUM	3
CONSTITUTION	3

TOTAL SCORE IS- 21

FOLLOW UPS:

DATE	SYMPTOM CHANGES	PRESCRIPTION
27.04.2019	Complaints of knee joint pain persists <  initial movement  > continuous motion  Cervical region pain persist  Generals : good	Rx   1. THUJA 1M /1DOSE (HS) (One 30 sized medicated globule in one grain of sugar of milk –dry dose HS X 1 Day)  2. RHUSTOX 1M /14DOSES /1DOSE in 10ml aqua QDS(,( no .30 sized 1 medicated  globule in 10 ml aqua 10 drops  4 times per  day X 14 Days )    3. B.PILLS 3 X TDS   4 .B.DISC 1 X BD                                 X 2WEEKS
18.05.2019	Knee joint pain still persist but slightly better  Cervical region pain persist   Generals : good	Rx  1.RHUSTOX 1M /14DOSES /1Dose in 10ml aqua  QDS ,( no .30 sized 1 medicated  globule in 10 ml aqua 10 drops  4 times per  day X 14 Days )  2..B.PILLS 3X TDS 3.B.DISC 1XBD                             X14ays
03.07.2019	Pain from right upper part of humerus  which extending to fingers  Drawing type of pain Movements painful  H/O Hemorrhoids Bleeding while defecation last week  Burning pain occ  Knee joint pain feels better initially but now worse  Generals : Sleep : disturbed  Others : good BP: 118/90mmHg	Rx  1.RHUSTOX 1M /14DOSES /1Dose in 10ml aqua  QDS ,( no .30 sized 1 medicated  globule in 10 ml aqua 10 drops  4 times per  day X 14 Days )  2..B.PILLS 3X TDS 3.B.DISC 1XBD                             X14ays

20.07.2019	Pain in arm persist < exertion  Pain  while passing stool better  Hemorrhoids feel better  Bleeding on and off Pain in knee joint better  < standing  Weakness after eating felt	Rx  1. THUJA 1M /1DOSE (ST) (One 30 sized medicated globule in one grain of sugar of milk –dry dose  X 1 Day)  2. RHUSTOX 1M /14DOSES /1DOSE in 10ml aqua QDS(,( no .30 sized 1 medicated  globule in 10 ml aqua 10 drops  4 times per  day X 14 Days )     3. B.PILLS 3 X TDS    4 .B.DISC 1 X BD                                 X 2WEEKS
06.08.2019	Pain in the left arm feels  better but persist Pain in both the knee joint more in right knee feels  better  Pain while passing stools feels better  No bleeding  Itching of scalp  Hair fall, dandruff  Generals : good  BP :110/70mmHg	Rx  1.RHUSTOX 1M /14DOSES /1Dose in 10ml aqua  QDS ,( no .30 sized 1 medicated  globule in 10 ml aqua 10 drops  4 times per  day X 14 Days )  2..B.PILLS 3X TDS 3.B.DISC 1XBD                             X14ays  .

PHILOSOPHY OF PRESCRIPTION:

DISCUSSION: Potency: According to the susceptibility of the patient during the current state of disease and to avoid the chances of medicinal aggravation.

Aphorism 183
Whenever, therefore, the dose of the first medicine ceases to have a beneficial effect (if the newly developed symptoms do not, by reason of their gravity, demand more speedy aid – which, however, from the minuteness of the dose of homoeopathic medicine, and in very chronic diseases, is excessively rare), a new examination of the disease must be instituted, the status morbi as it now is must be noted down, and a second homoeopathic remedy selected in accordance with it, which shall exactly suit the present state, and one which shall be all the more appropriate can then be found, as the group of symptoms has become larger and more complete.

Intercurrent Remedies: Sometimes in a chronic case we find that the action of a well-indicated constitutional remedy gets blocked and the patient refuses to make further progress. Under the circumstances, we should make a detailed study of the symptomatology and
the circumstances of its occurrence. Analysis from the miasmatic standpoint might indicate the type of miasm responsible for this block and a suitable anti-miasmatic remedy will help to remove it and restore the sensitivity to the constitutional remedy. In some cases, a troublesome symptom like burning of the soles might crop up and will be removed by Sulphur 30 which may not answer the total picture presented by the patient. As at times, with a family history of Tuberculosis a few doses of Tuberculinum might prove helpful.

Occasionally the case will be met which is not at all susceptible to the indicated remedy. In such cases the temporary insensibility to medicine may be traced to the previous abuse of medicine, or to an exciting regimen. If time and the exigencies of the case permit, it is sometimes best to cease all medication for a few days and carefully regulate the diet and regimen. Then medication may be resumed, using, according to the temperament and constitution of the patient, either a low or a medium potency. Hahnemann has recommended in such cases, the administration of Opium, in one of the lowest potencies, every eight or twelve hours until some signs of reaction are this means, he says, the susceptibility is increased and new symptoms of the disease are Laurocerasus, Sulphur and Thuja are other remedies suited to such conditions. They sometimes serve to arouse the organism to reaction so that indicated remedies will act. Remedies used in this way are known as “Intercurrents.”. The nosodes, Psorinum, syphilinum, Medorrhinum, Tuberculinum are also to be remembered in this condition, in cases where the latent diseases represented by these medicines are present, as shown by the existent symptoms or by the history and previous symptoms of the case. A single dose of the appropriate nosode in a moderately high potency, will sometimes clear up a case into view which will make it possible to select the remedy required to carry on the case successfully.Such the remedies must be based upon a careful examination and study of the history of the case and not merely upon empirical assumptions. Here, as elsewhere, individualization and the law of similia must guide. 

CASE SUMMARY
The patient presented with complaints of pricking pain both knee joints especially pain extending to right knee joint to thigh and to ankle joint since 1 1/2 years, and also she had the complaints of cervical region pain with numbness and the pain extending up to left elbow joint 1 year .She was treated with RHUSTOX 1M and THUJA as an intercurrent remedy with which there is gradual improvement of the symptoms as well as the health condition of the patient.

CONCULSION: Thus from this case we have learned about the importance of THUJA as an intercurrent remedy in the troubles of arthritic complaints.

REFERENCES:

1. Dhawale M.L. Principles and practice of homoeopathy. Bombay: Institute of clinical research; 2000. P. 284.
2. Banerjea Kumar Subrata. Miasmatic Prescribing. Comparison of the extremity symptoms. New Delhi: B. Jain Publishers (P) Ltd; 2015. P.131,132.
3. Boericke William. Pocket manual of Homoeopathic Materia Medica and Repertory. New Delhi: B. Jain Publishers (P) Ltd; 2015. P. 168.
4. Hahnemann Samuel. Organon of Medicine. 5^th & 6^th edition. New Delhi: B. Jain Publishers (P) Ltd ; 2005. P. 179.
5. Close Stuart. The Genius of Homoeopathy Lectures and Essays on Homoeopathic Philosophy. New Delhi: B. Jain Publishers (P) Ltd; 2012. P. 249.