Thursday, 9 June 2016

Pneumonia, a Series of Six Indicated Medicines



The pathological definition of pneumonia is the acute Inflammation of the lung parenchyma distal to the terminal bronchioles which consist of the respiratory bronchioles, alveolar ducts, alveolar sacs and alveoli. The focus of the article is the therapeutics of pneumonia. Not all the indicated remedies are mentioned. Rather six of the most prominent remedies are presented here, as how they follow each other as the disease progress. Please be forewarned that not all the cases require all of these remedies. It could also happen that a remedy out of this series may be required. Selection of a remedy for a case should always be in the true homoeopathic way, in pneumonia or in any disease for that matter. This article also aims to understand how the remedies be correlated with the pathology of a disease condition, how they could follow each other with respect to the pathology.


I shall add a short note on the pathology of pneumonia, as is necessary for this article. Pneumonia has several classifications. The bacterial pneumonia are classified into lobar pneumonia and bronchopneumonia (lobular pneumonia). Lobar pneumonia involves a part of a lobe, the entire lobe,or even two lobes of one or both the lungs. The bronchopneumonia is the infection of the terminal bronchioles that extends into the surrounding alveoli resulting in patchy consolidation of the lung.
The pathological changes in lobar pneumonia has four stages.
  1. Stage of Congestion: This is the early acute Inflammatory response and lasts for 1to2 days. There is dilatation and Congestion of the capillaries in the alveolar walls. Pale eosinophilic oedema fluid fill in the air spaces.
  2. Red Hepatisation: This is the phase of early consolidation and lasts for 2to4 days. There is marked cellular exudate of red blood cells and neutrophils making the alveolar septa less prominent. The oedema fluid is replaced by fibrin. This stage is accompanied by serofibrinous pleurisy.
  3. Grey Hepatisation: This phase of late consolidation lasts for 4to8 days. The fibrin strands are dense and more numerous. The cellular exudate is lesser and is separated from the septal walls by a thin clear space. Fibrinous pleurisy is prominent.
  4. Resolution: This stage begins by 8th to 9th day and is completed in 1 to 3 weeks. The previously solid fibrinous constituent is liquefied by enzymatic action, eventually restoring the normal aeration in the lungs. Resolution proceeds in a progressive manner. The pleural reaction may also show resolution but may undergo organisation leading to fibrinous obliteration of pleural cavity.  
The pathological changes in bronchopneumonia involves acute bronchiolitis, suppurative exudate and thickening of the alveolar septa. The less involved alveoli contain oedema fluid.

The major symptoms of pneumonia are shaking chills, fever, malaise with pleuritic chest pain, dyspnoea and cough with expectoration which may be mucoid, purulent or even bloody.

The six major remedies in pneumonia in order are Aconite, Bryonia, Phosphorus, Sulphur, Lachesis and Cannabis Indica. The homoeopathic treatment of pneumonia does not consist in giving these remedies in succession through the progress of the disease, to its termination. The prescription should be based on careful individualisation of each case, and adaptation of the remedy to its demands according to the law of similar. According to Dr. Wells“The remedy first chosen is to be continued in use so long as the case improves under its action, and no longer. So of the second, third, fourth, etc., if the case require so many. It is not often, when the process of inflammation of the lungs is once set up, that it is removed in the shortest time, with the best results, with one remedy. It is sometimes. The more common experience is, that under the action of a right remedy the case improves for a time and to a certain degree, when it ceases to progress favorably, and another remedy is required, the first not being similar to all the elements of the case.” It should be kept in mind, that the remedies indicated in the stage of Congestion will no longer be indicated when the consolidation is complete.

The remedies presented below are not complete in terms of its symptomatology. They have to be studied from the source books. Only the guidelines are given. It may be difficult to understand which stage the disease is,when the patient comes before the physician. For this purpose the history taking and examination should be thorough, as symptoms and signs are the indicators of the same.

ACONITE

The symptoms of the early stages of pneumonia correspond closely with that of Aconite. It's action is beneficial in the stage of Congestion up to a period when the deposits are just being formed. But once the Inflammatory product is deposited, this drug will no longer be of value.
The chills, fever, full hard pulse all point to Aconite. The onset of the disease is sudden and violent. The respiratory symptoms would be cough, aggravated by drinking, lying. Cough with pain in larynx, dry cough.There is shooting, tearing, burning pain in chest. The expectoration is scanty and streaked with bright red blood. There is oppression of respiration as well.

BRYONIA

Bryonia is the next remedy in the series. It is frequently required, but should be used only when it is the similimum. Bryonia becomes indicated in the stage of consolidation. It is also complicated with pleurisy. Bryonia does not help once the consolidation is complete.
The restless state of Aconite patient passes to a passive state in Bryonia. Bryonia prefers the right side.The cough becomes looser, the chest pains while coughing. There expectoration is copious mixed with blood, rusty expectoration. The patient desires perfect quiet and rest, as motion increases the troubles. The pleurisy is presented as stabbing pains in the chest, sensation of pressure in the chest, aggravated by motion and respiration too.

PHOSPHORUS

Phosphorus is often blindly given in pneumonia, irrespective of the symptomatology or the depth of the case probably because it has proven to be beneficial in several cases. Phosphorus is frequently indicated in the stage when the hepatization is complete, in the later part of the deposit and earlier part of the resolution. It is also a good choice in bronchopneumonia when the symptoms correspond. When the pleural is involved, Phosphorus may not become indicated in the earlier stages but is still useful for the absorption of the Inflammatory product. But when there is bronchial involvement, Phosphorus becomes indicated at a much earlier stage. When Arsenic has been the remedy, Phosphorus follows it, in pneumonia.
The cough is painful in Phosphorus. The cough is with shooting pains to epigastrium, hypochondria or the chest itself is painful. Constriction of the chest with dry, hacking cough. The expectoration of blood or frothy mucus. Burning in the chest. Suffocation or inspiration becomes almost impossible. The patient begins to show increased weakness.

SULPHUR

Sulphur becomes indicated when the latent psora becomes active. This is shown when the patient does not show any response to the treatment and the symptoms and the disease itself continue to increase. Sulphur here is a saviour. In this case Sulphur by itself will continue to do good or in some cases another remedy may be needed to follow it. Sulphur itself need not be repeated in these cases. The golden rule of not interfering while the case is improving must be followed here.  Sulphur helps in clearing up the lingering chest complaints that develop after pneumonia. These complaints could last for a considerable time and Sulphur clears it up.The other condition where Sulphur becomes imperative is in the resolution stage of pneumonia when Phosphorus has stopped working. It maybe that Sulphur becomes indicated instead of Phosphorus.Care should be taken as in any case with homoeopathy, that Sulphur be the similimum here, otherwise it will not help.
Sensation of a load in the chest. The cough has become loose with greenish expectoration, rattling in the chest, dyspnoea, heaviness in the chest are just some of the symptoms of Sulphur.

LACHESIS

Lachesis is indicated in the resolution stage of pneumonia. Another condition for the indication of Lachesis is when pneumonia occur as a complication in other diseases, eg: whooping cough. The cough comes during sleep or on waking up. There is dyspnoea, burning pain in the chest. Pressure on chest as from a weight, principally at night. Fits of Suffocation on lying down in evening or in bed at night.

CANNABIS INDICA

Cannabis Indica aids in the absorption of the cellular exudate, mainly indicated in bronchopneumonia. Some of the symptoms of Cannabis would be cough with greenish expectoration, fever with delirium, oppressed breathing. Restless sleep with delirium and loud moaning. Eructations with stitches in the left side of the chest.

Besides, the remedies listed above there are several other remedies too which may be indicated in some cases. Ant tart, Ipecac, Belladonna, Senega, Squilla are just to name a few. As with any diseases in homoeopathic practice, care should be taken to give the similimum.

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