Stomach flu and homoeopathic therapeutics

Dr Shweta Jha

ABSTRACT: Acute gastroenteritis or ‘stomach flu’ is inflammation and/or irritation of the lining of the stomach and small and large intestines, that can cause anorexia, nausea, vomiting, diarrhoea and/or abdominal pain that lasts less than 14 days. 

The acute infectious gastroenteritis form is a major cause of morbidity and childhood mortality. Because of vomiting and diarrhoea, dehydration is common. 

ETIOLOGY: Depending upon the specific organisms (viruses, bacteria or parasites) involved, the different acute infectious causes include: 

1. Non-inflammatory
2. Inflammatory 

NON-INFLAMMATORY	INFLAMMATORY
Viral       Noroviruses, astrovirus, rotavirus,   adenovirus	Viral                      Cytomegalovirus
Protozoa             Giardia lamblia, Cyclospora	Protozoal                    Entamoeba histolytica
Bacterial  Preformed enterotoxin production – Staphylococcus aureus Enterotoxin production – Enterotoxigenic E coli (ETEC)	Bacterial  Cytotoxin production – Clostridium difficile Mucosal invasion – Shigella, Salmonella
Essentials of Diagnosis Watery, nonbloody diarrhoea Mild, self-limited Non-invasive organism  Diagnostic evaluation – limited to patients with diarrhoea that is severe or persists beyond 7 days.	Essentials of Diagnosis Bloody diarrhoea  Pus or fever Invasive or toxin-producing organism Diagnostic evaluation – routine stool bacterial cultures, testing for ova and parasites.

HOW IT SPREAD?

The mode of transmission is primarily faecal-oral route. The faecal-oral transmission may be 

• Water-borne
• Food-borne
• Direct transmission in children (via fingers, fomites, dirt ingestion)

CLINICAL FEATURES:

1. Viral gastroenteritis

• Watery diarrhoea is most common
• Vomiting and fever > 39° C (>102.2° F)
• Headache, myalgias

2. Bacterial gastroenteritis

• Invasive – may result in fever, prostration, and bloody diarrhoea
• Illness with C. difficile infection ranges from mild abdominal cramps and mucus filled diarrhoea to severe haemorrhagic colitis and shock.

3. Parasitic gastroenteritis

• Fatigue
• Weight loss with persistent diarrhoea

 DIAGNOSIS:

• Acute diarrhoea (≤ 7 days)
• ARE THE FOLLOWING PRESENT?

1. Severe illness: T > 38.5° C, abdominal pain, bloody diarrhoea
2. > 6 stools/ 24 hours, dehydration
3. Elderly patient (> 70 yrs)

• If YES, send for stool testing for:

1. Fecal leukocytes
2. Routine stool culture
3. Ova and parasite testing

COMPLICATIONS:

• Metabolic alkalosis with hypochloraemia if vomiting is main cause
• Metabolic acidosis if diarrhoea is more prominent
• Malnutrition in children
• Hypokalemia and Hyponatraemia 
• Sepsis, encephalopathy in dysenteric illness

GENERAL MANAGEMENT:

1. PREVENTION

• Disinfection of drinking water at home
• Safe food handling practices
• Improved sanitation

2. (ORS) Oral Rehydration Solution Therapy for all ages during the first four hours

HOMOEOPATHIC MANAGEMENT:

1. Camphora officinalis – involuntary diarrhoea. Rice-water stools, with great prostration; whole body becomes icy cold and blue; even tongue is cold; yet a great dislike to be covered. Cold sensation in stomach and followed by burning; vomiting without much nausea. Camphor produces an atonic state of the intestinal canal, and is useful in diarrhoea. Improvement on thinking about complaint.

Dose: Tincture, in drop doses; 2x 

2. Ipecacuanha – the chief gastric indication for this remedy is found in its persistent nausea and vomiting. An ineffectual desire to vomit. Even after vomiting, the nausea instead of subsiding becomes aggravated hundred folds. Symptoms brought by rich food, like pastry, pork, fruits and ice cream. Stools poured with a gush, with appearance of fermented yeast and spurts out with much flatus. In colour, lemon yellow or green as grass, like frothy molasses, with griping at navel. 

Dose: third to 200^th potency

3. Veratrum album – diarrhoea is very painful, watery, copious and forcibly evacuated by great prostration, with violent cramps in calves, thighs and masseter muscles. Excessive thirst. Sudden onset. Sinking and empty feeling in the abdomen. Vomiting accompanies the purging; copious vomiting and nausea aggravated by drinking and least motion. Cold sweat on forehead with slightest activity. Craves fruits, juicy and cold things. Averse warm food. 

Dose: first to thirtieth potency

4. Achyranthes aspera – frequent painless, watery, profuse, involuntary stools with vomiting, prostration, intense thirst, thready pulse.  

Dose: 1x, 2x

5. Chaparro amargoso – specific in chronic diarrhoea. Stools with little pain, but with profuse mucus.

Dose: mother tincture; third attenuation

6. Gambogia – useful in acute and chronic cases of diarrhoea. Stools come out all at once with suddenness of urging; forcible ejection of bilious stools. Immediately after the stool, feeling of great relief in abdomen, as if some irritating substances were removed from intestines. Burning in anus after stools. Stools are profuse, watery, sometimes yellow, sometimes greenish and lienteric. Watery diarrhoea in hot weather.

Dose: third to thirtieth potency

7. Trombidium muscae domesticate – an invaluable remedy for treatment of diarrhoea and dysentery, proved by Dr. Hering. Its grand keynote is aggravation after eating and drinking. Urgent loose stool after rising from bed, expelled with great force. Occur generally after dinner or supper; there is hardly any evacuation after breakfast. 

Dose: sixth to thirtieth potency

8. Arsenicum album – putrid, involuntary stools with intense agony, prostration and burning thirst. Brought on by bad meat, vegetables, water melons, watery fruits, ice cream and vinegar. Frequent thirst for small quantities of water; marked symptoms are restlessness, anxiety and burning. Body cold as ice. Nausea, retching, vomiting after eating or drinking. 

Dose: third to thirtieth potency

9. Aloe socotrina – loud rumbling and gurgling in the abdomen, as though water were running out of a bottle. Aggravation of symptoms after meals. Abdomen feels full, hot, heavy, bloated. Colic before and during stools. The character of Aloe stool is equally striking. It is mostly transparent, jelly like in dysentery and yellow semi-liquid fecal in diarrhoea. This diarrhoea is always worse while walking or standing and is often followed by great prostration and fainting spells. 

Dose: sixth potency and higher

10. Podophyllum peltatum – painless, profuse stools which are offensive, gushing and cause quick dehydration. Prolapse of rectum before or with stool even from least exertion. Hot, sour belching; nausea and vomiting. Thirst for large quantities of cold water but no desire for food. Vomiting of hot, frothy mucus. Can lie comfortably only on stomach. Sensation as if genital organs would come out during stools. Diarrhoea brought by eating fruits. 

Dose: tincture to sixth potency

11. Croton tiglium – persistent diarrhoea and purging; stool expelled suddenly, as if shot out all at once; stools mostly yellow and watery, at times greenish; stools preceded by colic and borborygmus. Worse drinking the least quantity, or even while eating and on movement. Swashing sensation in the intestines. 

Dose: sixth to thirtieth potency

12. Eucalyptus globulus – acute diarrhoea. Aching pain in bowel with a feeling of impending diarrhoea. Stools thin, watery, preceded by sharp pains. 

Dose: tincture in one to 20 drop doses

13. Euphorbium officinarum – chronic diarrhoea accompanied with cerebral irritation and delirium. Stools fermented, profuse, clayey.

Dose: 1x; third to sixth potency

14. Mutha – diarrhoea with indigestion

Dose: 2x

REFERENCES: 

1. Munjal YP. API textbook of medicine. 9th ed. Vol. 1. Mumbai, mumbai: Dr. Yash Pal Munjal for and on behalf of The Association of Physicians of India; 2012.
2. Porter RS, editor. The Merck manual. 19th ed. United States: Gary Zelko; 2011.
3. Maxine A Papadakis; Stephen J McPhee; Michael W Rabow. Current medical diagnosis & treatment 2018. 57th ed. New York, N.Y: McGraw Hill Medical; 2018.
4. Park K. Parks textbook of preventive and social medicine. 22nd ed. India: Bhanot Publishers; 2017.
5. Digestive Disorders [Internet]. WebMD. WebMD; 2018 [cited 2020Feb17]. Available from: http://www.webmd.com/
6. Boericke W. Boerickes new manual of homoeopathic materia medica with repertory including Indian drugs, nosodes, uncommon rare remedies, mother tinctures, relationships, sides of the body, drug affinities, & list of abbreviations. New Delhi: B Jain Publishers; 2007.
7. Jain V. Mother tinctures: therapeutics and materia medica. New Delhi: B. Jain; 2006.
8. Burt WH. Physiological materia medica: containing all that is known of the physiological action of our remedies: together with their characteristic indications and pharmacology. 3rd ed. New Delhi: Jain; 2016.
9. Choudhuri NM. A study on materia medica: an ideal text-book for homoeopathic students. Noida, U.P., India: B. Jain Publishers (P) Ltd.; 2016.

Dr. Shweta Jha
M.D. ScholarPractice Of Medicine
Father Muller Homoeopathic Medical College And Hospital, Mangalore
Email ID – drshweta328@gmail.com