MY EXPERIENCE WITH KALI BROM IN A CASE OF POLYCYSTIC OVARIAN SYNDROMEParul G. Wadhwani MD (HOM)Reader, Department of Gynaecology and Obstetrics, Nehru Homoeopathic MedicalCollege and Hospital, Dte. Of AYUSH, Govt. of NCT of Delhi. India.E mail: drparulwadhwani@gmail.com

Abstract Polycystic ovarian syndrome (PCOS) is a heterogeneous collection of signs and symptoms, which is a leading cause of infertility and one of the top reproductive endocrine disorders in the world today. A 26-years-oldunmarried female consulted for the samein the gynecology OPD of Nehru Homoeopathic Medical College & Hospital. The most striking feature (characteristic or keynote) of the case was pustular acne with unsightly scars,which led to selection of Kali brom. Three doses of Kali brom 30 relieved the presenting complaints within 2-3 months. Facial hirsutism also decreased over following months.Ultrasonography repeated after 6 months revealed a normal study.

Keywords Polycystic ovarian syndrome, homoeopathy, kali brom, characteristic feature, striking symptom

Introduction Polycystic ovarian syndrome (PCOS) is a heterogeneous collection of signs and symptoms, which form a spectrum of mild to severe disturbances of reproductive, endocrine and metabolic functions. It is a leading cause of infertility and one of the top reproductive endocrine disorders in the world today.

While there are a number of definitions of PCOS, the Rotterdam consensus[1] is the most widely accepted, which requires the presence of any two of the following: Oligo/anovulation Hyperandrogenism Clinical (hirsutism or less commonly male pattern alopecia) or Biochemical (raised FAI or free testosterone) Polycystic ovaries on ultrasoundand exclusion of other aetiologies (congenital adrenal hyperplasias, androgensecreting tumours, Cushings syndrome)

The condition was possibly recognized even by the Father of Medicine, Hippocrates, as he observedthe girls get amazingly flabby and podgy.fatness and flabbiness are to blame. The womb is unable to receive the semen and they menstruate infrequently and little.[2]

Two Chicago doctors, Irving Stein and Michael Leventhal, first diagnosed PCOS in the early 1930s and reported their findings in a 1935 article published in the American Journal of Obstetrics and Gynecology. Hence, it was called Stein and Leventhal Syndrome.

The disorder is multifactorial in origin. A genetic etiology is strongly suspected but the severity and course is determined by the life style, especially body mass index. The inheritance is X-linked and female relatives should be screened, as 50% would have PCOS.

The patients may consult for/ present with any of the following complaint: Irregular or absent menstrual cycles Hirsutism and male pattern balding consistent with hyperandrogenism Subfertility or infertility Psychological symptoms anxiety, depression, psychosexual dysfunction, eating disorders Metabolic features obesity, dyslipidaemia, diabetes Acanthosisnigricans etc.

Common long term complications of PCOS include:1. Diabetes mellitus 2. Dyslipidemia3. Hypertension and cardiovascular disease4. Endometrial hyperplasia and endometrial carcinoma5. Sleep apnea etc.

The diagnosis may be confirmed with the help of Ultrasonography or serological markers viz.1. Serum FSH and LH (on day 2-3 of menses or any day if amenorrhoeic)2. Serum total and free testosterone3. Serum DHEA (dehydroepiandrostenedione)4. Serum insulin fasting and PP5. TSH6. Serum prolactin7. Lipid profile

Modern medicine advises the following treatment options depending on the chief presenting complaint: Oligomenorrhoea/amenorrhoea:Lifestyle change (510% weight loss + structured exercise); Combined oral contraceptive pill, Cyclic progestins; Metformin (improves ovulation and menstrual cyclicity) Hirsutism: Self-administered and professional cosmetic therapy with laser technique. Infertility: Lifestyle change- smoking cessation, optimal weight, exercise and folate supplementation; advice regarding the age-related decline in fertility to allow optimal timing of family planning; Infertility therapies may include clomiphene, metformin, gonadotrophins, surgery and in vitro fertilisation Cardiometabolic risk: Lifestyle change

Homoeopathic approachAgainst the minimalistic approach of dominant medicine, homoeopathy takes into account not only the complete medical history of the patient but also herpersonal history including lifestyle, occupational conditions, familial scenario and psycho-emotional aspect. Considering every individual as unique as her fingerprint, the focus is to identify the personality of the female presenting with a kind of PCOS in order to select an appropriate remedy.Therefore, one woman with PCOS may take a completely different remedy from another in order to have relief.

Sanchez-Resendiz and Guzman Gomez F. did a research with 36 cases of PCOS who fitted the mental picture of Pulsatilla, were given Pulsatilla 6C, 4 hourly throughout the day for 2 weeks after the end of menstruation and this was repeated for 4 consecutive cycles. At the end of the trial 30 of the 36 women had complete disappearance of symptoms and production of normal ovulating follicles and a further 4 of the 36 became asymptomatic.[3]

I share with you a case of PCOS successfully treated in the OPD of Nehru Homoeopathic Medical College & Hospital.

Case ReportA 26-years-old unmarried girl(OPD reg no. 26814) of heavier built and dark complexion consulted on 22nd May 2012 for PCOS.

Her primary (and obvious) complaint was of severe acne on cheeks, forehead and chin since college time. The eruptions were painful, pustular and left behind deep scars and blemishes and aggravated before menses. She had tried numerous topical applications for them with temporary relief.

Simultaneously she also noticed hair growth in the chin region. However, in last one year she noticed a sudden increase in facial hair growth for which she consulted a local physician who advised an ultrasonography.

24/04/12: Ultrasonography- Both ovaries are normal in size and show small cysts in the periphery amidst a hyperechoicstroma. Impression polycystic ovarian pathology suggested.

She also complained of pre-menstrual mucoidal vaginal discharge.

There was also a tendency to take cold easily and post nasal dripping at every change of weather since childhood. During summers, she suffered with epistaxis.

Menstrual historyMenarche: 13 yearsCycle: 25/5 days, flow adequate. LMP: 7-5-12

Past historyH/o severe insect bite with allergic reaction at 15 years of age.Jaundice 4 years back.

Family history:Mother: hypertension, uterine fibroids (hysterectomy done)Father: hypertension

Generals:Thermal reaction: can tolerate cold weather easilyThirst: small quantities in small intervalsDesires: sweet, milk, cold drinks, warm foodStool: unsatisfactory and hardPerspiration: on upper lipSleep: left side, refreshing

AnalysisThe most marked and striking feature of the case was the deep scars left behind by acne.It reminded me of the keynote symptom mentioned under Kali brom in Henry Clay Allens Keynotes, Acne: simplex, indurate, rosacea; bluish-red pustular, on face, chest, shoulders; leaves unsightly scars (Carbo an); in young fleshy women of gross habits.[4]

After going through John Henry Clarkes MateriaMedica (see discussion below) I gained further confidence in the remedy.

Prescription & follow upDateFollow upPrescription

22/05/12Kali brom 30/ 3 doses to be taken 6 hourly on day one.Placebo 30/ tds for 1 month

13/06/12Slight improvement in the acne and constipation was better Placebo 30/tds for 1 month

25/07/12Acne much better; no new hair growth on chin; bowels normal; menses regularPlacebo 30/tds for 2 months

26/09/12Acne better; scarring decreased; no increase in facial hirsutism and hair on chin much softer.Placebo 30/tds for 1 month

17/10/12Improvement continues. Placebo 30/tds for 1 month

07/11/12Face quite clear, no blemishes, scarring decreased;facial hirsutism lesser. Advised ultrasonography.Placebo 30/tds for 1 month

27/11/12: Ultrasonography- Both ovaries are normal in size, normal in position and show normal echo pattern. Impression: sonological study is within normal limits.

It has been nearly 2 years since she first consulted at NHMC OPD. She still visits on and off (for seasonal complaints or with someone else) but her hirsutism has decreased considerably and she continues to be well.

Discussion & ConclusionHahnemann laid down the guidelines for characteristic features in aphorism 153 of Organon wherein he writes, the more striking, singular, uncommon and peculiar (characteristic) signs and symptoms of the case of disease are chiefly and most solely to be kept in view; for it is more particularly these that very similar ones in the list of symptoms of the selected medicine must correspond to, in order to constitute it the most suitable for effecting the cure...[5]

The foremost quality of a characteristic feature ought to be striking; that is to say, a feature that is on your face and you just cant overlook. Even if it is a pathological feature or a pathognomonic symptom, it needs to be considered unless totality points strongly in another direction.

In the above-mentioned case, the unsightly scars were most striking feature and reminded me of the Henry Clay Allens keynote (another nomenclature of characteristic) symptom of Kali brom (as mentioned above under analysis).

Drawing an analogy between medicine and music, prescribing on the characteristics was termed by Henry Newell Guernsey, Adolph von Lippe, Henry Clay Allen, etc., as keynote prescribing. There is only one keynote to any piece of music, however, complicated, and that note governs all the others in the various parts, no matter how many variations, trills accompaniments, etc., In both the patient and remedy to be selected, there is and must be a peculiar combination of symptoms, a characteristic or keynote. Strike that and all the others are easily touched, attuned or sounded.[6]

I had a similar experience as when I referred to John Henry Clarkes MateriaMedica, I found, Acne has a very definite relation to the sexual organs, being especially noticeable at puberty and, in women at the menstrual period... A number of cases of ovarian cyst have disappeared under its action, also fibroids and fatty tumours.[7]

William Boericke in his MateriaMedica has also mentioned under the chapter on Kali brom, Cystic tumors of Ovaries under section female and Acne of face, pustules under section on skin.[8]

Keynote prescribing may appear novel, and even at first glance objectionable, prescription is based on a single symptom, but that is not what it is. The case reported here demonstrates this, and confirms the efficacy of keynote prescribing as a way to use MateriaMedica guided by homoeopathic philosophy to add to our storehouse of evidence-based medicine, the need of the hour.[9]

And the result of three doses of Kali brom 30 has not only helped a woman regain health and get rid of PCOS but also bolstered my belief in the teachings of Hahnemann (characteristic features and minimum dose) that governed the practice of all the stalwarts of homoeopathy.

References:

1. http://humrep.oxfordjournals.org/content/19/1/41/T1.expansion.html accessed on 9-2-15.2. Hippocrates. Airs, Waters, Places-Chapter 20-22 accessed on 9-2-15 at http://www.well.com/~aquarius/hippocrates.htm3. Sanchez-Resendiz J, Guzman-Gomez F. Polycystic Ovary Syndrome. BoletinMexicano de Homeopatica, 30; 1997;pp 11-15.4. Allen HC. Keynotes and characteristics with comparisons of some of the leading remedies of materiamedica. Economic Homoeo Pharmacy, Calcutta; Fifth Indian Edition (Enlarged) 1983; pp 154.5. Hahnemann S. Organon of medicine, 6th ed. B Jain Publishers (P) Ltd,Delhi; Reprint edition 2004; pp 1586. Close S. The genius of homoeopathy, Ch XI- Symptomatology. Pratap Medical Publishers Pvt Ltd.,New Delhi; pp 160.7. Clarke JH. A Dictionary of Practical MateriaMedica as accessed 0n 9-2-15 at http://hpathy.com/e-books/dictionary-of-practical-materia-medica-by-j-h-clarke/kali-bromatum-kali-br-3/8. Boericke W. Pocket manual of homoeopathic materiamedica and repertory. B Jain PublishersPvt Ltd, Delhi; Reprint edition 1999; pp 365-366.9. Wadhwani GG. A case of parkinson-plus syndrome resolved using the 'lost art' of keynote prescribing. AJHM Summer 2012;105: pp70-75.