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Repertorial approach of jaundice with it’s homoeopathic indications

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KNOW Homoeopathy Journal Vol–2 & Issue-2, 18 October 2022, Published at at https://www.knowhomoeopathyjournal.com/2022/10/volume-2-issue-2.html, Pages: 46 to 61, Title: Repertorial approach of jaundice with it’s homoeopathic indications, Authored By: :- Dr. Jagdish Thebar (Professor and H.O.D., Department of Practice of Medicine, Swasthya Kalyan Homoeopathic Medical College & Research Center, Jaipur, Rajasthan, India) & Co-Authored By: Dr. Sunil R. Thumar (M.D. (PGR), Department of Practice of Medicine, Swasthya Kalyan Homoeopathic Medical College & Research Center, Jaipur, Rajasthan, India)

Title: Repertorial approach of jaundice with it’s homoeopathic indications

Authored By:- Dr. Jagdish Thebar [1] & Co-Authored by: Dr. Sunil R. Thumar [2]

[1] Professor and H.O.D., Department of Practice of Medicine, Swasthya Kalyan Homoeopathic Medical College & Research Center, Jaipur, Rajasthan, India

[2] M.D. (PGR), Department of Practice of Medicine, Swasthya Kalyan Homoeopathic Medical College & Research Center, Jaipur, Rajasthan, India


Received: 29/08/2022            Accepted: 15/09/2022       Published: 18/10/2022

© 2022 KNOW Homoeopathy Journal https://www.knowhomoeopathyjournal.com/p/copyright-policy.html

How to cite this article:

Thebar J, Thumar S. Repertorial approach of jaundice with it’s homoeopathic indications. KNOW Homoeopathy Journal, 2022; 2(2):46-61, available at https://www.knowhomoeopathyjournal.com/2022/10/repertorial-approach-jaundice-with-homoeopathic-indications.html


ABSTRACT        

“The word "jaundice," which means yellow in French, is "jaune." The word "icterus," which has Greek roots, is the medical name for jaundice. Jaundice will result from an overabundance of bile pigment in the blood. Pigment deposits are seen in the eyes, mucous membranes, and skin. The amount of bile pigment in the circulation, how quickly it diffuses into the tissue, and how readily bilirubin is absorbed and bound by the tissue all affect the hue to varying degrees. Jaundice is fully explained here along with its homoeopathic treatment.”

 

INTRODUCTION [2, 3]

Clinically jaundice is noticeable when serum bilirubin reaches 2-3 mg/dl. When serum bilirubin is between 1-3 mg/dL, jaundice is typically in its latent state, clinically non-evident, yet only detectable by serum analysis.

When the direct bilirubin level is less than 15% of the total serum bilirubin, it is said to have unconjugated hyperbilirubinemia. When the direct bilirubin level is more than 15%, it is referred to as conjugated hyperbilirubinemia.


DEFINITION

Jaundice, or icterus is a yellowish discoloration of tissue resulting from the deposition of bilirubin.

Normal Range of bilirubin:

Serum Bilirubin: 0.3 - 1 mg/dl 

Conjugated Bilirubin level: 0.1 – 0.3 mg/dl

Unconjugated Bilirubin level: 0.2 – 0.7 mg/dl


SITES OF EXAMINATION

      Upper bulbar conjunctiva (eyes)

       Mucous membrane of soft palate

       Palms and soles (extremities)

       General skin surface (especially where soft skin)

       Base of tongue


TYPES OF JAUNDICE [2, 3, 4]

1.    Pre hepatic / Hemolytic jaundice

2.    Hepatic / Hepatocellular  jaundice

3.    Post hepatic / Obstructive / Surgical / Cholestatic jaundice


Pre hepatic / Hemolytic jaundice

Excessive unconjugated bilirubin is created in pre-hepatic or hemolytic jaundice quicker than the liver can conjugate it for elimination. Hemolytic or pre-hepatic jaundice is caused by pre-hepatic phase dysfunction. There are few causes given bellow which lead to development of  this condition.

1.      Inherited

·         Hereditary defect or RBC membrane proteins absence (e.g. Spherocytosis)

·         G6PD deficiency, Pyruvate kinase deficiency (enzyme deficiency hemolysis)

·         Sickle cell anemia (Abnormal Hb synthesis)

2.      Acquired

·         Microangiopathic hemolytic anemia (HUS, DIC, ITP, Malignant HTN, etc.)

·   Paroxysmal nocturnal hematuria (PNH). Primary intrinsic defect in cell membrane and secondary to bone marrow disorder like aplastic anemia

·         Spur cell anemia (spick cell membrane - acanthocyte)

·         Immune haemolysis (seen in hypersensitive 2 reaction)

·         Parasitic infections (Malaria s/o hepatosplenomegaly)

3.      Ineffective erythropoiesis

·         Cobalamin, Folate deficiency (Megaloblastic anemia)

·         Severe iron deficiencies (Microcytic hypochromic anemia)

·         Thalassemia

4.      Increased bilirubin production

·         Massive blood transfusion

·         Resorption of hematoma

5.      Drugs

·         Rifampicin, ribavirin, Probenecid


Hepatic / Hepatocellular Jaundice

Normal hepatocytes are destroyed in hepatic jaundice and as results the liver's capacity to conjugate bilirubin is compromised. Increased levels of conjugated and unconjugated bilirubin are seen in this disease. There are few cause given bellow which lead to develop this condition.

1.      Viral Hepatitis

     HAV, HBV, HCV, HDV, HEV, EBV, CMV and HSV

2.      Alcoholic Hepatitis

     160g/day for 10-20yrs alcohol consumption

      Balloon degeneration (cell swelling and enlargement), fibrosis of parenchymal tissue

3.      Drug Toxicity

     Acetaminophen

     Isoniazid (AKT)

4.      Environmental Toxins

     Vinyl chloride, Jamaica bush tea-pyrrolizidine alkaloids, kava kava, Wild mushrooms

5.      Wilson's disease

6.      Autoimmune hepatitis

     Anti smooth muscle antibody

7.      Inherited conditions 

      Indirect hyperbilirubinemia

1.    Gilbert syndrome

2.    Crigler-najjar syndrome  

      Direct hyperbilirubinemia

1.    Dubin Johnson Syndrome

2.     Rotor syndrome


Post hepatic / Obstructive / Surgical / Cholestatic jaundice

The term "post-hepatic jaundice" describes biliary drainage blockage. A conjugated hyperbilirubinemia will develop from the liver conjugating the bilirubin that is not eliminated. The rate of bilirubin production is typical. In such disorder causing a blockage to the passage of bile whether it is intra or extra hepatic. There are two cause given bellow which lead to develop this condition.

1.      Intrahepatic Causes

·         Viral hepatitis

·         Alcoholic hepatitis

·         Primary biliary cirrhosis

·         Primary sclerosing cholangitis

·      Vanishing bile duct syndrome: Chronic rejection of liver transplants, Sarcoidosis drugs

· Drug Toxicity: Pure cholestasis- anabolic and contraceptive steroids Cholestatic hepatitis- chlorpromazine, erythromycin estolate

Chronic cholestasis- prochlorperazine and chlorpromazine

·       Congestive hepatopathy and ischemic hepatitis

·       Veno-occlusive disease

·       Graft versus host disease

·       Infiltrative disease: Tuberculosis, Amyloidosis, and Lymphomas

·       Cholestasis of pregnancy

·       Non hepato biliary sepsis

·       Benign post operative cholestasis

·       Paraneoplastic syndrome

·       Infections: Malaria, Leptospirosis

·  Inherited conditions: progressive familial intrahepatic cholestasis, Benign recurrent cholestsis

2. Extra hepatic cause

·  Malignant conditions like Cholangiocarcinoma, Gallbladder cancer, Pancreatic cancer, Ampullary carcinoma, malignant involvement of porta hepatis lymph nodes

·  Benign conditions like Choledocolithiasis, post operative biliary strictures, Primary sclerosing cholangitis, Chronic pancreatitis, AIDS Cholangiopathy, Ascariasis


SIGNS AND SYMPTOMS [3, 4]

Early features

- Yellowish discoloration of skin, sclera, etc

- Pale/Clay colored stool

- Dark color urine

Late Features

 - Malabsorption (Weight loss, Steatorrhea)

 - Osteomalacia

 - Fever, Rigor, pain (features of cholangitis)

 - Increased bleeding tendency


INVESTIGATION [2, 3, 4]

1.      Serum / Urine / Stool Bilirubin

2.      AST / ALT (Raised due to damage liver parenchyma)

3.      Plasma albumin < Plasma globulins (due to increase production of antibodies)

4.      USG (To differentiate intra and extra hepatic cause of jaundice)

5.      CT Scan

6.      MRI (MRCP – to visulised hepato biliary tree)

7.      Biopsy


GENERAL MANAGEMENT

Ø  Treatment depends on the underlying cause.

Ø  Dietary changes such as eat lots of raw fruits and vegetables (especially green leafy vegetables), Juice, do not drink coffee, alcohol, soda pop, other junk food drinks, Avoid red meat and animal fats, Reduce dairy products cheese, milk, and others

Ø  May involve removal of the offending agent.

Ø  Administration of antibiotic, antiviral, antifungal, or anti parasitic drugs as per underlying cause

Ø  Surgery to correct blockage.

Ø  Light exercise e.g. yoga, walk and stretching or rest and restricted activity of body

Ø  Get proper sleep

Ø  Drink 6-8 glasses of water per day

Ø  A colon intestinal cleansing is helpful

Ø  Do not smoke and avoid passive smoke


REPERTORIAL APPROACH IN HOMOEOPATHY [5]

Murphy’s Repertory

Brain - COMA, unconsciousness - jaundice, in

Children - JAUNDICE, newborn infants, in

Constitutions - CHILDREN, constitutions - jaundiced

Constitutions - COMPLEXIONS, general - sallow - jaundice

Constitutions - INFANTS, constitutions - jaundice

Constitutions - WEAK, constitutions - jaundice, from

Diseases - CANCER, general - liver, cancer - jaundice, with

Diseases - FATTY degeneration, organs - fatty, degeneration, liver - jaundice, malignant, and a gone, weak sensation in abdomen

Diseases - GALLSTONE, colic, pain - jaundice, with

Diseases - HEPATITIS, liver - jaundice, with

Diseases - JAUNDICE

Diseases - MALARIA - jaundice, with

Emergency - COMA, unconsciousness - jaundice, in

Female - MENSES, general - ailments, of menses - jaundice, with

Female - MENSES, general - jaundice, with

Female - MENSES, general - suppressed - jaundice, with

Fevers - HECTIC fever - jaundice

Fevers - MALARIA, fever - jaundice, with

Generals - WEAKNESS, sensation of being - jaundice, from

Hands - YELLOW - jaundice, in enlargement of liver

Heart - WEAK, heart - diarrhea, with, in jaundice

Intestines - DUODENUM, general - catarrh - jaundice, in

Intestines - INDURATION, during jaundice

Liver - ATROPHY, of - acute - jaundice, from

Liver - BILE, general - increased then deficiency, jaundice, with

Liver - CANCER, liver - jaundice, with

Liver - CONGESTION - jaundice, with

Liver - DULL pain - jaundice, with

Liver - ENLARGED - jaundice, in

Liver - FATTY, degeneration, liver - jaundice, malignant, and a gone, weak sensation in abdomen

Liver - FULLNESS, sensation - jaundice, with

Liver - GALLSTONE, colic pain from - jaundice, with

Liver - HEPATITIS, infection - jaundice, with

Liver - INDURATION, of - jaundice, with

Liver - JAUNDICE

Liver - PAIN, liver - jaundice, in

Liver - PRESSING, pain - jaundice, painful, in

Liver - SHARP, pain - jaundice, in

Liver - SORE, pain - jaundice, in

Liver - WEAK, liver - jaundice, with, from biliary concretions

Liver - WEAK, liver - jaundice, with, from biliary concretions - jaundice and great depression of mind, with constipation

Mind - CONSCIOUSNESS, general - confusion of, with jaundic

Mind - GRIEF, ailments from - jaundice, causes

Pregnancy - JAUNDICE

Pregnancy - SKIN, during - discoloration, yellow, jaundice, during

Pulse - FAST, pulse, elevated, exalted - heat in face, with flushes of, and congestion to chest - heat of skin, with, in jaundice

Pulse - SLOW, pulse - jaundice, in

Rectum - CONSTIPATION, general - gall-stones, jaundice, with

Rectum - DIARRHEA, general - jaundice, during

Skin - DRY, skin - jaundice, in

Skin - ITCHING - jaundice, during

Skin - JAUNDICE

Stool - WATERY, stool - jaundice, with


Boericke O. Repertory

FACE - Appearance, condition - Jaundiced, yellow

ABDOMEN - Constipation - Concomitants - Gall-stones, jaundice

ABDOMEN - Diarrhoea, enteritis - Cause, occurrence - from - jaundice

ABDOMEN - Jaundice

FEMALE SEXUAL SYSTEM - Menstruation - type - Suppressed - with - jaundice

FEVER - Apyrexia - Jaundice

NERVOUS SYSTEM - Adynamia - From - jaundice


Boger C. Boenninghausen’s Repertory

HYPOCHONDRIA - Aggravation - jaundice, during

EXTERNAL ABDOMEN - Jaundice

SENSATIONS AND COMPLAINTS IN GENERAL - Infants, affections of - jaundice

SKIN AND EXTERIOR BODY - Color - yellow, jaundice


Complete Repertory

MIND - CONFUSION of mind - jaundice, wit

MIND - DEATH - conviction of - jaundice, in

MIND - SADNESS, despondency, depression, melancholy - jaundice, with

MIND - STUPOR - jaundice, in

MIND - UNCONSCIOUSNESS, coma - jaundice, in, all day

MIND - WEEPING, tearful mood - tendency - jaundice, in

HEAD PAIN - GENERAL - jaundice, with

FACE - JAUNDICE

STOMACH - APPETITE - diminished - jaundice, with

STOMACH - APPETITE - wanting - jaundice, with

STOMACH - NAUSEA - jaundice, with

STOMACH - VOMITING - General - jaundice, during

ABDOMEN - JAUNDICE

ABDOMEN - TUMORS - Liver, cancerous - jaundice, with

RECTUM - CONSTIPATION - gallstones, jaundice, with

RECTUM - DIARRHEA - jaundice, during

STOOL - COLOR - clay colored - jaundice, in

STOOL - WATERY - jaundice, with

FEMALE - MENSES - General - jaundice, with

FEMALE - MENSES - suppressed - jaundice, with

EXTREMITIES - ITCHING - Hand - palm - jaundice, in

CHILL - JAUNDICE, during

FEVER, HEAT - HEAT - absent - jaundice, with

SKIN - DISCOLORATION - yellow, jaundice, icterus, etc.

SKIN - DRY - jaundice, in

SKIN - ITCHING - jaundice, during

SKIN - JAUNDICE

GENERALITIES - FOOD and drinks - food in general - aversion to, loathing to - jaundice, with

GENERALITIES - JAUNDICE

GENERALITIES - WEAKNESS, enervation, exhaustion, prostration, infirmity - jaundice, from


Phatak S. R. Concise Repertory

D - Diarrhoea - jaundice, with

D - Dropsy oedema - jaundice, with

I - Itching - jaundice, in

J - Jaundice

L - Liver - cancer - jaundice, with

M - Menses - absent, suppressed, amenorrhoea - jaundice, with

P - Palms - itching - jaundice, in

S - Skin - dry - jaundice, in

S - Stools - watery, thin - jaundice, with


HOMOEOPATHIC THERAPEUTIC[6]

Arsenicum Album

Enlargement of liver and spleen with aching localized part, Abdomen swollen and painful, Burning pains which improve by heat, face become pale, yellow, cachectic, marked restlessness with exhaustion and Periodic Fever, Burning sensation, Constant of being left alone and death, cannot bear the sight or smell of food, nausea, retching, vomiting after eating or drinking

Bryonia Alba

Tearing pain in the abdominal region with > rest and < movement., liver region swollen with burning type of pain and tenderness of abdominal walls, Stomach is very sensitive to touch, Dryness in eyes, mouth, lips, physical weakness, Irritability, Nausea in the morning, , Yellow, dry and pale skin with increased thirst

Cardus Marianus

Liver, and portal system causing soreness and pain at local part (liver region/right upper abdominal region) associate with jaundice, Hyperemia of liver with Cirrhosis, Swelling of gall bladder with pain and tenderness, Abuse of alcoholic beverages, especially beer with dropsy, stool is bright yellow in color, Urine is almost golden yellow in color, Soreness and pain all over the body

Chionanthus

Hepatic derangement, enlarge spleen, gall stones, paroxysmal abdominal pain, yellow conjunctiva, jaundice with arrest of menses, aching of umbilical region, stool soft, yellow and pasty and clay coloured, bilious colic, hepatic region tender, bile present in urine, urine very dark, yellow skin

Chelidonium Majus

It is used for treating various liver disorders. It has various properties like anti-viral, anti-inflammatory, anti-tumour, and anti-microbial. It is useful in case of gallstones and gall bladder obstruction with jaundice, continuous pain under the lower tip of the right shoulder blade, Skin is jaundiced with bright yellow, pasty, clay colored stool, eyes are dirty yellow color of whites, face also yellow, liver enlarge with gall stone.

China Offcinalis

Intermittent fever with pain in right hypochondriac region, gall stone colic associate with liver and spleen swollen and enlarge, due to loss of fluids from the body generalized weakness occure, Periodicity of symptoms, stool undigested, frothy, yellow and yellow discoloration of the whites of the eyes, Vomiting of undigested food, Face also has a sallow complexion and looks dull, Excessive flatulence with Bloated feeling of abdomen which gets better by walking

Cholesterinum

Obstinate hepatic engorgement, gall stones, useful fir carcinoma of liver, burning pain in side, hypoglobular anemia, hypertrophy of spleen, it is useful in the action of bile and its salts with hepatic affections

Lycopodium Clavatum

It is affected right side of the body, Skin shows yellowish spots with brown color pigmented spots on the abdomen with bloated sensation, Presence of red sediment in urine, Lying on the painful side is very difficult due to sensitiveness of liver, dropsy due to hepatic disease, hepatitis with atrophic form of nutmeg liver. Pain shooting across lower abdomen from right to left

Myrica

Marked action on liver with jaundice, yelloe sclerotic, yellow face, bronze yellow skin with itching, dull pain in region of liver, fullness in stomach and abdomen, yellow high colored urine (biliary) and light or ash colored stool with bile.

Natrum Phosphoricum

Yellow creamy coating on back and roof of mouth and tongue, discharge from eye is golden yellow and whites of eyes dirty yellow, sour eructions, sour vomiting with greenish diarrhea, yellow skin associate with itching in various parts

Nux Vomica

It is useful remedy who live modern life. Heaviness and feeling of weight in the stomach with nausea after meal, Bruised soreness of abdominal wall with portal congestion, Liver engorged along with stitching pain and soreness, spasmodic colic, diarrhea with jaundice

Phosphorus

Liver region is congested, acute hepatitis, fatty degeneration of liver and Inflammation, Acute viral liver infection, Yellowness in skin, large yellow spot on abdomen, Anaemia with discharge blood from stool, haematuria


REFERENCES

1. Jaundice historical perspective-wikidoc. (2011). Wikidoc. https://www.wikidoc.org/index. php/Jaundicehistorical_perspective#:~:text=Jaundice%20comes%20from%20the%20French%20word%20ja

2. Larry, Anthony, Dennis, Stephen, Dan, & Joseph. (n.d.). Harrison’s Principles of Internal Medicine, Twentieth Edition. McGraw-Hill Education / Medical.

3. Lee, G. M., & Andrew, S. M. (n.d.). Goldman-Cecil Medicine, 2-Volume Set (Cecil Textbook of Medicine). Elsevier.

4. P munjal, Y. API Textbook of medicine. (10 ed.). India: Jaypee brothers medical publisher (p) ltd ;2015.

5. RADAR 10 Computer software

6. Boericke W. New Manual of Homoeopathic Materia Medica & Repertory. New Delhi: B. Jain Publisher, Third revised & augmented edition, 2008, 448-450; 413-415; 286-287; 65-66; 545-548; 362-366; 464-466; 72-75; 579-580.


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