Jan 2015|Vol 12|Iss1

   
 
Case
 
   
Dynamic concepts to expertise in Vitiligo treatment
 

 

Dr.R.Gnanasambandam, a renowned clinician and academician, research scholar writes and shares his views in this article for efficacy of Homoeopathy in Vitiligo treatment. He had authored books and articles published in scientific journal. He also presented many papers in the scientific conferences, lectured in many Homoeopathic Medical Colleges. He served in many positions in the state and central GovernmentHe can be contacted at 6, Llyod's II Lane Royapettah, Chennai -600014

 
 
 

Introduction

     Even though the realm of cure of Vitiligo is implausible, Homoeopathy has clinically evidenced certain cures. Such evidence based results had been achieved by the genius of Homoeopathy. The genius lies in two important aspects. Dynamic concept of Medicine enables to act to the core level on the dynamic disease and individualistic approach. Vitiligo is a dynamic disease with scarcity of symptoms. This one sided disease can be clinically applied successfully by miasmatic and individualistic approach.

Understanding pathophysiology

     We know each and every cell is structural and functional Unit of the body. The Melenocytes which are responsible for melanin undergo changes by physical, chemical and metabolic causes. Genetics also play a role in this pigmentary disorder. The melanocyte either it go for functional disturbances and sometimes destructive changes by the influences. The disease is mostly auto immune, however neural and chemical stimulation encountered in some case. Leucoderma usually results from external trauma, where Vitiligo always bows with internal derangement. Among the localized type of vitiligo focal and segmental lesions are expressed along the course of cutaneous nerves. In generalized vitiligo, the Acro facial varieties are gradual in onset, where as the Vulgaris is almost sudden and quick.

Clinical Organon of Medicine

     Hahnemann had laid he also classified the clinical presentation in to different classes, types, and sub-types with a clear message, laid down the fundamental principles in order to achieve the desired result. Hahnemann classified this chronic malady Vitiligo dynamic. We consider the classification “One side Disease” Since there is scarcity of symptoms “disease with few symptoms” The symptom is not completed since sensation modalities are established to fit. Hahnemann in § 175
     In one-sided diseases of the first kind it is often to be attributed to the medical observer’s want of discernment that he does not fully discover the symptoms actually present which would enable him to complete the sketch of the portrait of the disease.
     Hahnemann emphasize to obtain complete portrait in § 5
Useful to the physician assisting to cure are that particulars of the most probable exciting cause of the acute disease , as also the most significant points in the whole history of the chronic disease to enable him to discover the fundamental cause especially due to a chronic miasm . In these investigations , the ascertainable physical constitution patient (especially when the disease is chronic) his moral, and intellectual characters , his occupation , mode of living and habits , his social and domestic relations , his age, sexual function etc are to be taken into considerations
Here he insists the past History, Family History of patients and discover the miasm since Vitiligo is chronic and he also emphasize the constitutional prescription understanding the most integral part, the miasms
We know that the miasms are the dynamic disease producing power which pollutes the human organism and become the producer of every possible diseased condition. These alerted manifestations irritate and sensitize the Melanocytes leading to functional disturbance, induration and even destruction. This pathophysiology can be easily understandable by Hahn emann’s sayings in § 74, while describing the Artificial chronic diseases

……. and either deprive some part of its irritability and sensibility, or exalt these to an excessive degree cause dilatation or contraction, relaxation or induration or even total destruction of certain parts, and develop faulty organic alterations here and there in the interior or the exterior Cripple the body internally or externally), in order to preserve the organism from complete destruction of the life by the ever – renewed, hostile assaults of such defective forces

     Thus we can clinically apply organon of Medicine according to Hahnemann’s inspiration the vitiligo undergoes the miasmatic changes scientifically. Psora is functional changes in the cell sensitized by irritability. Such irritability usually caused by exciting and maintaining causes, acute miasms (infections) metabolic changes and inheritance resulting hypopigmentary lesions in the skin and mucous membranes. Such changes are noted in focal, segmental and mucosal varieties. In Leucodermas maintaining causes are the sequel of the ailment
A melanocyte may undergo induration as observed in generalized vitiligo. Both in acro facial and vulgaris types undergo self destructive which is mostly observed in Auto immune response and genetic cause will reveal the pathophysiology of a melanocyte. These quick changes can be applied as Psora Syphilis (Pseudo Psora) changes, which is revocable. When the vitiligo is congenital, complete destruction of cell results in Syphilitic changes which cannot be reversible as in cases of albinism and Piebaldism.

     The sycotic manifestations are less in vitiligo, however found as a causative factor in thyroid disorders with goiter, Additions disease etc.

Clinical Materia Medica
     Even though Anamnesis can be made out several remedies, always polycrests are highly useful clinically. They usually bring the inert healing power portrait of the picture matched understanding the constitution and miasmatic perspectives. The expression of miasm can be identified by both physical and mental attributes

Arsenicum Album
     When we suspect any infection, toxins, insect bite served as exiting cause this remedy always beneficial. Many patients give the past history of prolonged illness like typhoid, Jaundice, Alcoholism, drug abuse and prolonged usage could predisposed. Metabolic disease like Hypothyroidism, and Diabetes could call these remedies. Clinically Arsenicum Album ranked high in cures since it covers all the miasmatic state in physical and mental levels

Natrum Mur
     When the patient is suspected anaemic, Urticaria in the past history. Key features of constitutional back up lead the remedy

Nitric Acid

     Clinically this remedy had tremendous results in white discoloration in lips and genitals owing to the sphere of action. Further family History of similar complaints and proliferative diathesis will be the key features

Thuja Occidentalis

     Thuja is almost helpful like Ars Alb if we suspect any inoculations and vaccinations would have been exciting cause. When the key features present the surface miasm as auto immune, would call for indication

Lycopodium

     A clinically successful remedy which calls by indication on gastric ailments, liver affections and Nutritional factors

     Silicea and Selenium are also helpful. Neither Biochemics, Mother Tinctures nor external applications are needed for the radical cure. Dynamised Medicine will prove the efficacy of Homoeopathy. Of course the Mother tinctures Psoralia Cornifolia, Piper Methysticum, Hydrocotyle Asiatica can be used when the cases do not respond. Some specific organopathic remedies as Mica for lips, Ars Sulph Flavatum is commercialized earlier eventhough specific indications called for the remedy. We do not need any Biochemic tissue remedies to support.

Clinical Applications

     My personal experience gained when I joined the Government Homoeopathy Medical College at Kilpauk Chennai. One day I with my friends Dr.P.Mukundan and Dr.A.Kamaraj were standing infront of the Outpatient department, we saw a man with vitiligo lesions all over the body. He looked like a foreigner. After few months we are surprised to see the patient with remarkable recovery, only palms and soles remained with white patches. We had conversion with him and he told that he had the lesions since 10 years and were better only after the homoeopathic treatment.
     We were curious to know the case details. We approached Dr.S.Sembulingam, the internee in duty; he told Prof Dr.K.P.R.S.Santhana Pandian had treated the case with Lycopodium 30C. We contacted him and he taught us how to treat the case and his clinical experience in the treatment of vitiligo
     This was a great visual evidence for homoeopathy that we gained more confidence in the homoeopathic system and there we had laid the foundation stone for the today’s excellence
     After my studies I started my initial days practice at my native Avalpoondurai, in 1983. I had an opportunity to treat a boy aged 14 years who had white patchy discolouration in his left and right fingers. He had burns while lighting the crackers to celebrate Diwali. The wound heeled but the skin was depigmented. I considered the causative factor as chemical injury and prescribed the medicine Arsenicum Album 1M. Surprisingly the patient improved within four months and the lesions turned to normal skin. I personally gained confidence to handle the vitiligo patients and more interested to continue, learn and dedicate to the system by serving the humanity. The photographs of small lesions taken during and after gave more enthusiasm in search for radical cures (Refer Plate I and Plate II)

 

     The total registry of 867 vitiligo cases 2001 to 2014 at our concern. In earlier days of practice I usually prescribe a indicated polycrest followed with some complementary medicines. I tried mother tinctures and oil babchi external application to expedite the recovery. In search of recovery to my patients, I made an exclusive visit to Fr Muller’s Homoeopathy Medical College to obtain a external application Leudermal from my senior Prof. Dr. Sunny Mathew.

     On due course gradually I inspired the wonders of potentisation and hence started experimenting with mostly preferable drug Arsenicum Album for some range of patients, then it gave me the insight of understanding the miasm in every case interpreting the physical and mental attributes and prescribing with potencies alone. Now I do not seek for any auxiliary measures with Mother Tinctures or any external application. I was quite surprised when the lancet controversy was thrown on our system. Even though the prescribed research protocols which were not applicable to homoeopathic studies, Arsenicum Album1M would have brought tremendous results. I state that only Randomized control studies are quite applicable since our system is based on individualizations. Such case studies would bring the magic of minimum dose. We enjoy cure from a small lesion to extensive. A 56 years old patient with Vitiligo Vulgaris had reverted to almost normal with short span of treatment (Refer Plate III and Plate IV). I have published case studies, articles, books for public awareness which gives more expertise in clinical studies

     Even though the entry of registry is high, many skip the treatment for obvious reasons. The community expression on incurability results in discontinuation and non cooperation. However we succeeded to some extent by clinical evidences on few cases which resulted cure after 1-2 years. A case of vitiligo vulgaris responded to Nitric Acid 200, repeated once in a month after two years. I have seen many patients with dark complexion would give quick result, rather than fair complexion.I have authourded two books on Vitiligo or public awareness and my case studies on vitiligo published in journals.

Potency Selection and Repetition

     Centesimal Potencies 200C to 1M always gives desirable results. Monthly, bi monthly repetition of single dose is enough to arouse the dynamism, considering span of action of the drug. I usually choose the three pills three times administered on the first day followed with placebo, keeping in mind on the power of antidotes. We do not change the remedy unless the expression of miasm as per Aphorism No 206

     Repetition of the indicated drug in high potency shall be t repeated according to the susceptibility of the patients. Usually one a month ideal of choice. The additional complaints particularly in acute, low potencies are preferable.

Diet and Regimen

     Diet is common observation and expected guidelines from patients. Scientifically the animal proteins prone to accelerate immune response, hence it is better to advise to adhere with vegetarian diet and give away from all non vegetarian food. Ascorbic Acid tend to interfere with melanosynthesis, hence all ascorbic acid rich foods shall be restricted to some extent.

Conclusion

     Homoeopathy excels in the treatment of Vitiligo, beyond the doubts. Even though the way of approach differs to physician to physician, the supremacy of cure can be explained scientifically by understanding the miasms. Indeed we are in need for more evidence based studies which could enable to enter the mainstream of medicine.

References
1. Organon of Medicine 6th Edition
2. Allen’s Key Notes and Characteristics – H.C.Allen
3. Leaders In Homoeopathic Therapeutics by E. B. NASH
4. Homœopathic Materia Medica by William BOERICKE, M.D.
5. Leucoderma, Dr S.R.Wadia
6. Miracle of Mother Tincture Yadubir Sinha