The respiratory tract is the most common focus for prescribing in General Practice. This is because our system of airways is a very vulnerable interface with our environment. Consequently it is a point of entry for viruses, bacteria, potential allergens, pollutants and irritants and it is the primary location for the many illnesses associated with these triggers.
Mammals have evolved many defence mechanisms to address these airbourne challenges. Our surface immunity is a very complex entity which involves: (1) agents that we secrete into the surface mucus, (2) agents carried in the lymphatic ducts and (3) agents bourne by the blood supply. The various specialised cells, antibodies and enzymes involved in these processes also require a host of balancing mechanisms in the host; including our ability to (a) invoke a fever on demand, (b) generate a protective catarrh and (c) preserve the physical movement of air and secretions, (d) dynamically alter the balance between the regional perfusion (of blood) and the air flow into the alveolar sacs.
Fortunately, most respiratory challenges throughout life resolve themselves. Most viral colds and coughs are best left untreated in the healthy person, because there is simply very little that can be done to improve the ‘systems intelligence' that we have evolved. (Although a vast amount of money is made spuriously by drug manufacturers whose symptomatic drugs have no impact on our immune response and sometimes even prolong overall recovery.)
Viral Respiratory Infections
Sometimes a viral respiratory illness can linger on uncomfortably. The symptoms are often a reflection of the virus itself, since different respiratory viruses preferentially involve different tissues in the respiratory tract.
Patient's who are overzealous with their symptomatic drugs, who suppress their fever, or who are otherwise compromised by a slow immune response, can develop problems with their defence mechanisms. The more delayed or protracted the response is, the more they are likely to get swollen lymph glands and persistent catarrh.
An immune system ‘distracted' will also fail to deal with changes in the bacterial flora. This can result in secondary growths of streptococcus, pnemococcus, haemophillus influenzae and other organisms. These germs are adapted to colonise certain tissues (tonsils, middle ear, bronchi etc.) where they can cause considerable local inflammation.
Those infections which provoke a marked lymphatic response, with tender swelling of the cervical neck glands, often require acute remedies like Phytolacca decandra. After a well chosen remedy, the lymph bourne defences become much more efficient and the host can usually then eradicate the primary infection for itself. Mumps infection often involves secretory glands including the parotid salivary glands and Trillium pendulum can be helpful in shortening and ameliorating the symptoms.
The homoeopathic leading symptoms are dependant on 1. the organism, 2. the primary site of the infection and 3. the host's physiological response. Very few upper respiratory infections require antibiotics; even those that are bacterial in origin, if they are quickly and expertly prescribed for homoeopathically. [Here we could put in a clinical example of a 11 year old boy treated for Streptococcal tonsillitis with Phytolacca and Streptococcinum]
The first task is to provide the remedy which most closely reflects the current physiological state. Depending on the response, the primary treatment will be followed by a secondary similimum, or a potency of the infecting organism itself (nosode) - but only once the primary acute symptoms are subsiding.
The timing of prescriptions is very important and depends on the ‘acuteness' of the presentation, the ‘reactiveness' of the symptoms, the age of the patient and the type of remedy used. (Most acute illnesses require treatment with plant remedies. The symptom pictures of the plants are strongly influenced by their dominant alkaloids and the characteristic physiological reactions associated with these.)
The timing of the remedy sequence depends on the illness stage: Most viral illnesses progess through (a) inflammatory, (b) secretory, (c) virus shedding and (d) resolution stages. Each stage may indicate a change of prescription, particularly if there is a hitch in the host's natural process of adaptation. Remedies should be selected on the basis of the prevailing symptoms, which tend to reflect inefficiencies in the host's efforts to compensate. The following is a simple example of sequenced acute prescribing in viral croup.
Viral croup is a common condition in infancy. The renowned nineteenth century homeopath, Clemens von Boenninghausen, realised the phasic nature of the condition and the prescribing implications of each stage in the natural disease process. Boenninghausen's croup powders, comprising Aconitum napellus, Hepar sulph. calc. and Spongia tosta were given sequentially to effect the fastest recovery for each stage.
The Genus Epidemicus
Many people see individualisation as a central tenet in homeopathy, but it is probably truer to say that accurate pattern matching (between reactive symptoms and remedy) is the most important determinant of success. This is particularly true in acute prescribing for infectious illnesses, where a given virus can evoke a broadly similar reaction in many different people. Genus epidemicus is the term given to the combination of signs and symptoms consistently experienced by infected people during an outbreak of infections illness. The term is also used to denote the remedies of choice for the duration of that outbreak.
Notwithstanding the dangers of an over-formulaic approach to treatment (which are discussed below), Ailanthus glandosa is remarkably reliable in treatment of Glandular Fever (Epstein-Barr virus). This remedy can almost be considered the genus epidemicus for those clusters of cases that occur in the teenage population. Similarly this author has found Ipecachuana very reliable in infant bronchiolitis caused by the respiratory syncitial virus.
With modern networked communications it is now potentially possible for information on successful prescriptions to be disseminated the homoeopathic community during an epidemic, so that the genus epidemicus can be established early, to the benefit of the greatest number.
There are several good monographs available on the homoeopathic treatment of influenza. Some of these are rather overdue for updating and really should be distributed to the homoeopathic community at large (in time for the next global pandemic). Anyone who wants to understand the potential dangers of suppressing the primary fever in viral illnesses, only needs to read Thomas Sydenham who watched the effects of antipyretics (or their absence) on the fate of hundreds of people during the great viral haemorrhagic fevers of the seventeenth century. Patients should not take paracetamol-based drugs for the symptoms of ‘flu.
Oscillococcinum (Hepar et cordis barbarae) is a nosode prepared from the hearts and livers of wild ducks, which was employed in the treatment if influenza, long before it was known that wildfowl are the main reservoir and vector for influenza pandemics. There are good quality studies demonstrating the effectiveness of Oscillococcinum in the treatment of ‘flu. The identification of the acute homoeopathic similimum is, nevertheless, of paramount importance.
Avoiding Formulaic Treatments
There is a tendency in some prescribers to prescribe Atropa belladonna for every fever, when in fact the patient really needs Datura stramonium or Duboisinum, or Solanum dulcamara, or Baptisia tinctora, or China officinalis, or Ferrum phosphoricum (etc.) Inadequate differentiation by the prescriber; or the unfocused use of homeopathy simultaneously with symptomatic drugs and antibiotics, are common causes of prescribing failure.
One of the most obvious abuses is the overuse of Bryonia alba for coughs. Bryonia is a highly complex remedy with very clear guiding respiratory symptoms. Only a very small number of patients with persistent cough actually respond properly to this remedy. (ie those who reflect the Bryonia ‘state'). Some manufacturers provide Bryonia in a cough linctus. The syrups and linctuses to which it is added can themselves offer some comfort, but the Bryonia tends to actively block the response to well prescribed remedies, so it should never be used at the same time as expertly chosen remedies.
The issue of over-prescribing
It could be argued that over-prescribing is a modern-day problem for children, who are unable to make informed choices about their own treatment. Many children have never worked through a viral respiratory infection without concurrent exposure to paracetamol, ephedrine or antibiotics. We do not yet know whether drug-mediated alterations of acute physiology or immunology in our child population, might be implicated in the markedly increased incidence of childhood asthma and secretory otitis media (glue ear) in recent years. The emergence of this prescribing culture and these demographic trends have occurred over the same time-frame. Regardless of whether there are long term health consequences to phamacological meddling during childhood acutes, there are certainly millions of pounds wasted on symptomatic drugs which are needlessly administered for self-limiting conditions.
The respiratory microflora in health and illness
One of the most important determinants of health in the respiratory tract is the state of our microflora. Our bodies are host to many millions of micro-organisms which are in symbiotic relationships, with each other and with us. There has been a tendency in the past, to regard our microflora as an irrelvant or incidental group of passengers. Increasingly we are aware that the constituent nature of this microflora is important to our health.
If our passenger organisms belong to groups that don't release toxins or evoke inflammation, their presence can significantly inhibit the growth of those that can. The microflora of the respiratory tract changes during an infection, mainly because their physical and immune environment changes as the host tries to inhibit the primary pathogen. When left to itself the flora will usually revert back to a stable healthy state after the infection has been resolved.
However, when an infection has been prolonged because the host is debilitated, or subjected to the over-prescribing of symptomatic drugs, the microflora can evolve to a less healthy state (dysbiosis). Groups of less welcome organisms can overgrow and provoke persistent inflammation and catarrh.
Sometimes persistence of the primary pathogen is responsible, and homeopathically this might warrant potencies of eg. Haemophillus, Mycoplasma, Micrococcus, Streptococcus or whatever nosode is aetiologically relevant.
However, the residual disturbances in the respiratory microflora are usually made up of various aerobic bacteria. Many of these are generally regarded as harmless by bacteriologists, since they are often isolated from healthy people. When certain subspecies over-colonise, however, they cause problems which can persist long after the primary infection and antibiotic treatments are over. These often require a more complex nosode. Sycotic co is one of the most useful homoeopathic nosodes for persisting post-infective catarrh in the ears, nose, sinuses or lower airways. Sometimes potencies of Morbillinum (measles) is indicated in children who develop glue ear after measles or measles vaccination.
Dysbiosis and relapsing conditions of the airways
Bronchitis is an inflammation of the airways, which is often characterised by havi ng a relapsing or ‘acute on chronic' pattern. Although each acute flare-up seemingly responds to antibiotics, there is often a progressive change in the microflora. This is often attended by excessive secretions and persisting inflammatory change. Smoking and exposure to environmental irritants often compounds or perpetuates the problem.
When the perpetuating causes are left untreated, patients tend to develop increasingly frequent infections, attended with low-grade relapsing fevers. Longstanding inflammation can ultimately give rise to more serious cardio-respiratory complications. The cycles of infection can be often be broken by using Chininum sulph., Morgan pure, Bacillinum and those remedies which alter the secretory environment. Homoeopathic remedies can also be nebulised under medical guidance and this can be a particularly effective mode of remedy administration during acutes.
Treating Chronic Bronchitis
In the medium term, patients should be treated between the acute episodes. This can involve a wide range of remedies depending on the individual circumstances. Frequently indicated are the Kali salts, Ammonium salts, Antimonium salts, Chininum salts, Stannum salts, Sulphur Pulsatilla, Sambuccus nigra, Spongia tosta, Lobelia inflata (etc)
In chronic cases, there is nothing in homoeopathy that can fully redress the effects of smoking. Patients with chronic relapsing respiratory problems must stop smoking ... completely. The psychological aspects of the tobacco addiction may be amenable to homoeopathic treatment early in the withdrawal process.
There is a tendency to think of asthma as a definitive diagnosis, when in fact it is a spectrum of conditions, in which the principle symptom is transient constriction of the small airways. The context for this physiological phenomenon can be allergic, infective, physiological, and/or psycho-neuro-endocrine. This essentially means that the systems which mediate these unstable reactions in the lungs have a network of causes.
Genetic factors underlie the asthmatic tendency in many cases. An increased incidence of asthma has also been identified in children of mothers who have used paracetamol in pregnancy. Children brought up in very clean environments and who never encounter soil saprophytes are also at increased risk. In particular, the early exposure of children to mycobacteria [? graphic] has been shown to lower the incidence of asthma.
Good monitoring is vital in the treatment of asthma and inexpensive devices for the measurement of the expiratory flow rate, are an important way of establishing both the severity of the problem and the response to treatment.
A homoeopathic doctor will establish whether the presentation is predominantly allergy-mediated, infective or systemic. Various blood-tests and prick skin allergy testing can be helpful in establishing this. Responses to heat, cold, humidity, exercise, stress, menstrual cycles, drugs, inhalants, sleep-waking cycles, seasons (etc) all have significance, both in determining the category of asthma and in terms of the treatment programme.
Homoeopathic treatment can be highly successful for asthmatic patients. Nevertheless, anyone engaged in treatment of asthma should remember that a severe acute attack can be fatal. There is no room for complacency. Both the monitoring and treatment process has to dovetail in a responsible and consistent way with established orthodox guidelines for good practice. The photos alongside show children in whom the symptoms of asthma were eradicated completely using 1. An aetiological nosode, 2. Constitutional prescribing 3. A miasmatic nosode.
Those asthmatics who aggravate in September, as the weather gets colder, often have a demonstrable allergy to house dust mite. As heating devices are turned up in the autumn, much more house dust is bourne by the resulting air convection, to be inhaled by the sufferer. This allergic challenge can be compounded by viral challenges that prevail at this time of the year.
Many homoeopathic physicians will undertake prick-skin allergy testing in these patients, as a matter of routine. Regular doses of homoeopathic house dust mite in August, in combination with household measures to reduce exposure, can help to prevent autumn aggravations. The picture opposite shows a positive skin test to house dust mite in a patient with asthma, chronic catarrh and recurrent sinusitis. All three problems improved dramatically following isopathic treatment with potencies of house dust mite. (Patients should not use antihistamines before attending for prick-skin allergy testing, or falsely negative results might result.)
One of the most common misapprehensions concerning homoeopathy relates to its potential in serious illness. Many people mistakenly assume that this gentle therapy is only effective in mild conditions. Before the advent of antibiotics, the Royal London Homoeopathic Hospital received patients suffering from severe infections, on transfer from other hospitals in the city where there was no possibility for active treatment. Pneumonias by Douglas Borland is a treatise on the homoeopathic treatment of pneumonia which (although it is now in need of some updating) is a concise therapeutic guide, written directly from clinical experience.
Case records from the beginning of the twentieth century make interesting reading. They contain details of patients who recovered, under homeopathic treatment, from pneumonias and other severe infections. This picture shows the dramatic change in a patient's temperature chart following administration of a homoeopathic remedy.
It is important to remember that, among the successes, there are also a number of patients treated at the beginning of the twentieth century, who died and who would probably have survived with modern intensive care.
The converse irony is that today, after years of over prescribing, increasing numbers of our antibiotics are becoming ineffective, with the emergence of resistant bacterial strains. Once again we are faced with the prospect that orthodox medicine will be unable to offer active treatment in some severely ill patients. We can only hope that prejudice will not prevent the medical community from tapping into a long neglected homoeopathic knowledge base, for the sake of these patients.
The graph opposite [graphic 8.] shows the homoeopathic analysis of a young child with unresolved pneumonia, who was deteriorating after two hospital admissions and several courses of antibiotics. Her chest signs began to resolve within eighteen hours of homoeopathic treatment and she made a complete recovery.
In severe acutes our primary responsibility is to the safety of the patient, presented acutely with a severe chest infection and bronchospasm on a Friday afternoon. She was severely breathless at rest and virtually unable to speak. Her expiratory flow rate was unrecordable and her breath sounds were barely more than a faint creak on auscultation. This patient did not want hospital admission. We insisted, however, that she demonstrate an unequivocal remedy response within 30 minutes, or emergency hospital admission would be arranged for her. Her air entry began to improve rapidly following homoeopathic Squilla maritima and she returned home with a remedy sequence and strict instructions to call for help if the improvement was not maintained. By the time of her review, on the following Monday, she was markedly improved. She was completely free of respiratory signs and symptoms by the end of that week.
An Integrated Approach to Respiratory Medicine
Today's medical homeopaths have access to many investigative technologies that were unknown to their predecessors. The measurement of: viral titres in a patients blood; throat swabs; sputum cultures; X-rays; bronchoscopic samples/biopsies; and modern medical imaging, can all profoundly influence the homeopathic approach. These investigations allow the homoeopathic physician to select the correct aetiological nosode, for example, or a remedy with the best known affinities for the tissue or organ involved.
Mr S. has aspergillus, a fungal mass in his right lung which causes chronic suppuration. In this condition there is both an infective component and an allergic component, since the fungus produces spores which generate an allergic response resulting in ‘asthmatic spasm' of the airways and the trapping of infected secretions. In Mr S. the homoeopathic treatment was completely dependant on the accuracy of his diagnosis. [graphic 10.] Three doses of homoeopathic Aspergillus 30c, caused a very rapid dilatation of his bronchioles and the release of enormous quantities of infected material, pus and dead tissue. The respiratory physicians, who shared his care, were astounded by the changes in his x-ray appearance and lung-function tests.
There is a great potential for the increasing integration of homoeopathy in the management of respiratory illness. Much of this potential is gradually becoming realised in our educational programmes, where a pragmatic approach to the teaching of therapeutics will increasingly enable doctors to treat acutes responsibly and homoeopathically and thus prevent a great deal of chronic illness.
By Dr Russell Malcolm FFHom. MBChB BA FFHom Cert Voc Tr.
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