GALL-STONE AND ITS COMPLICATIONS : VALUE OF HOMOEOPATHIC TREATMENT.
1. Dyspepsia at the Beginning.
We are going to review the field of Homoeopathic treatment of the different manifestations of gall-stone. It is only a few years ago this question was broached, not only because new remedies were proposed, but mainly because the French school could codify with precision and adapt in a sure manner in each well determined clinical case, some medicines used so long without any method. This should be for us a lesson of humility, because very often there was want of precision which hindered the homoeopath to obtain good results even using the more old remedies of the Materia Medica. It is a variable dyspepsia, with pain, sometimes early at the end of meals (Robinia type), sometimes late like that of an ulcer (Nux vomica or Anacardium), calmed after eating. But the characteristic of this pain is that the pain is due to indigestion of special foods : Fatty food, eggs, iced foods, chocolate etc.
Sometimes even the Aerophagia reveals latent gall stone. When a radiographic plate is taken there is seen a vertical dislocation of the stomach (Faroy) and twisted pylora may be later on the seat of an ulcer. Sometimes the ulcer may be on the duodenum. For all these manifestations it is necessary to treat the patient in a strictly homoeopathic manner. In these cases one must remember the value of Gratiola, Nux vomica, Ignatia, Kali carbonicum also of Argentum nitricum and also of the value of the ground remedies : Thuja, Lycopodium, Graphites with Nux vomica, Ignatia, Kali carbonicum which are also remedies of temperament. Some times Prandial Diarrhoea is seen, which is a symptom of colitis as well as of the affection of gall bladder.
This diarrhoea immediately after meals is seen in Argentum Nitricum, China, Natrum Sulphuricum (diarrhoea immediately after breakfast)
Alternate constipation and diarrhoea will indicate according to the case Chelidonium or Chionanthus or Nux Vomica, Iris Versicolor, Jugluns Cinerea.
2. Affections and Troubles of Duodenum.
The progress in radiography obtained since some years have shown the relation between the Duodenum and the Gall Bladder. This is very important. There are two cases : 1. There may be Duodenal Spasm or even Ulcer formed after chronic dyspeptic troubles or more or less repeated dyspeptic troubles. In this case it is frequently seen that there is coexistence of functional troubles of the liver and of the bladder or there may already be vesicular lesions : Cholecystitis, with gall stone revealed or not in gall bladder.
In this cases, the ground remedy may be according to the temperament of the subject either Thuja, or Natrum sulphuricum, or Lycopodium (to be used prudently) and often Phosphorus, the most important remedy of temperament of Cholecystitis.
2. There may be some radiographic symptoms denoting the existence of a vesicular inflammation, Cholecystitis and Pericholecystitis, causing secondarily periduodenitis. There is then the Adhesions. If they are old, and organised they play the most important part in some painful phenomena. They should be treated by Silicea (ground-remedy, high dilution 200 or M), followed by Thiosinamine (in high dilution according to Cahis of Barcelona) by Calcarea Fluorica, Fluoric Acid.
What is interesting to note according to our personal opinion is that numerous patients from 40 to 60 years of age who have a long and long series of dyspeptic and duodenal troubles with cholecystitis in the beginning or pericholecystitis and periduodenitis, have at the sametime a precancer state; their general condition becomes bad, they become emaciated, they have numerous new skin symptoms : naevi, multiple warts etc. Often without X-ray the diagnosis is uncertain. And even when there certainly is not cancer one dose of Micrococcin 200, does good to them; they put on weight. One Kg. within 10 days.
It seems that these patients have arrived at a cross road. Before them there are two divergent roads leading to the same point, the road sclerosis which leads to cirrhosis, and more or less advanced senility; the other road leads to cancer. The organism choses one or the other and according to our experience we may say that even in this stage we may help the patients not to fall in the one or the other danger. But if our remedies come late, one of the two roads are chosen and utilised and there remains no hope for complete cure.
3. Hepatic Colic.
It is not possible to deal with it here. Let us only mention here some very simple remedies specially from the vegetable kingdom, which will help us to get a rapid and favourable result.
A. The Pain Characteristics :
1. Dioscoria villosa and Colocynthis which oppose each other.
2. Bryonia, Belladonna, Atropinum sulph & Chamomilla, related to the two above.
B. Hepato-biliary insufficiency, concomitant or anterior to the crisis or which follows it will indicate.
3. China, Berberis, Chelidonium, Chionanthus in simple cases. 4. Carduus marianus, Hydrastis, Arsenicum album in more serious cases.
C. The following constitutional remedies may also be used.
5. Calcarea carbonica, Nux vomica, Lycopodium, Phosphorus, Cholesterin.
4. The cholecystitis and the stone of Choledochous canal.
a. Limits of homoeopathic treatment and of surgery.
Before giving indications on the treatment of cholecystitis, let us precise first of all what are here the limits of actions of homoeopathy and of surgery.
Chronic cholecystitis may lead towards sclero-atrophy. It is in this case specially the duodenum and even the pylora may be united together by adhesions, with the possibility of stenosis or pylora requiring surgical intervention. After clinical and radiographic examination of the stomach, intestines and gall bladder, the physician will judge if the lesions are very chronic inveterate. We homoeopaths will yield the place of homoeopathy to surgery.
Very rarely there will be hydrocholecystitis, the bladder increases in volume and distends behind a calculous obstruction. In some cases homoeopathy may cure and in some cases help of surgery should be taken.
Finally if the cholecystitis is suppurated, it should be operated except in cases treated early by homoeopathy where a resorption may be obtained. Our internal remedies, our compresses with M.T. of selected medicines will have an admirable effect, but if the time presses, if the general condition of the patient is grave and when a gangrenous cholecystitis is feared, it is necessary to take recourse to surgery immediately. Our therapeutic results obtained in most of the cases of simple cholecystitis is sufficiently good, but we must be prudent, impartial and believing in surgery.
b. Homoeopathy and Lithiasic Temperament.
But what is very important, is to recognise the lithiasic temperament, already described by Paracelsus and we should know how to treat it.
A- How strange is the diathesis that obliges numerous organisms to the necessity to form stones. The Salivary Lithiasis, tartars of the teeth, ranula (There are some persons who have too much tartar of the teeth, other have very little), renal lithiasis, biliary stones, patchiatic lithiasis; intestinal or stercoral lithiasis, lithiasis of muscular and conjunctive tissues etc. There is a General Tendency to Calculus; that tendency seems often to have some nearest points and evolution with the Tendency to Sclerosis. It is due, some says to Arthritism; to Psora say the disciples of Hahnemann. These different terms serve only to veiour ignorance, because still we do not know the why and how of the tendency to stone. It only appears that the persons who have it evolves in some cases more or less rapidly towards senility, sometimes in advance, as also seen to evolve in the same sense but still more rapidly, those who have the tendency to sclerosis or to fibrosis.
What are the habitual homoeopathic remedies of persons whose evolution is towards sclerosis? Thuja, Plumbum and its salts, Baryum and its salts, Aurum and its salts, etc…and Silica, and Iodium.
For those who have the tendency to from stones, Thuja Calcarea Carbonica, and sometimes Sulphur, Natrum Sulphuricum, Lycopodium.
But bile stones are somewhat different from other stones. We know that chemically it is due to the deposit of Cholesterin. Cholesterin is a normal product of the blood. It is diminished in tuberculous patients and its use in gross doses will help cicatrisation in this disease. On the contrary it is increased in the blood of the plethorics who have the tendency to obesity or persons having hepato-biliary insufficiency.
In persons suffering from hypertension an increase is also seen. In arteriosclerotic persons, persons suffering from Bright’s disease and in some cases of pregnancy etc. What is the exact part played by cholesterin? Nothing is yet known. However it is known that it is antagonistic to lecithin and one finds almost always these two substances in the same case. By the side of hypercholesterinemia there is lipemia which is important to take into account and the phosphorated fat, lipoids in excess in the blood of some subjects having insufficient liver and the tendency to fabricate too much organic fat co-existing then with the increase of the percentage of cholesterin.
It seems then rational in these cases to try Cholesterium which seems to act better in high dilutions. It may be alternated with Phosphorus M, 200 or DM, every 8, 15, or 30 days. The effect is often remarkable. The patient no more fabricate calculus, and even if they exist, is not covered with a hard calcarious coating, We may cause diminution of their volume. Besides these cases, often the percentage of cholesterin in the Blood remains the same or high inspite of the general amelioration of the subject and also of the liver. It is therefore important to know the remedies that are indicated by lipemia which often leads to obesity and by hypercholesterinemia that may coexist with it or alone on its own account.
We have often mentioned these remedies. They are : Phosphorus, Graphites, Calcarea carbonica, Natrum sulphuricum, China, Cholesterinum and possible also Lecithin in ponderable doses.
China is classic (Cartier). It prevents biliary lithiasis. Graphites, Calcarea carbonica. Natrum sulphuricum evolves towards obesity, with frequent lipemia and often cholesterinemia.
Phosphorus seems to me marvellously indicated in persons who have cholesterinemia and great thirst, who, like Natrum Muriaticum, and Bryonia, drink large quantity of cold water, drink much during meals, because cholesterin is avid of water.
Moreover Phosphorus acts on degenerescents, which may cause excess of cholesterin in the blood and the tissues (arteritis, cataract etc.)
This question has not yet been solved but it seems to play an important part and later on it will be necessary to know well the homoeopathic remedies indicated by laboratory findings, also by subjective symptoms or by objective symptoms that individualises the patient.
B–By the side of Cholesterin diathesis there is the infection factor. Some micro-organisms have been discovered in the nucleus of the stones. The infections therefore play a determinating part in person predisposed to lithiasis.
Besides, almost half of chronic cholecystitics are not stone forming. Most of these cholecystitis which are not lithiasics are of intestinal origin, and seen in patients who are constipated with right sided painful stasis. It is perhaps the infection of the liver : enterohepatic syndrome or there is entero-renal syndrome.
These patients are to be treated like cholecystitic lithiasic patients, predominantly by medicines of infection than by remedying the lithiasis. But often in these cases there is also high rates of cholesterin. There is therefore between the two cases very close relation and probably the same etiology : Colibacillinum may be used and Enterococcin as well.
By the side of these cases, the infection, instead of being colibacillary may be Eberth’s bacillus. Cholecystitis of Acute Typhoid Fever, subacute or tending towards chronic stage. In these cases nosode Eberihinum may help.
But let there be infection or no infection the indicated remedies will generally be the same as those of lithiasic cholecystitis.
In order that lithiasic cholecystitis is formed, there must be at the sametime hepato-biliary insufficiency with the formation of stone and infection.
The hepato-biliary insufficiency is more or less profound. But by interrogating the patient it is easy to find that it has developed in a latent manner during long period before the phase of confirmed cholecystitis.
This affection is of extreme frequency and develops for some general causes in relation to the modern life, the shocks of all sorts that it gives to our sensorial organs and to our overworked modern sympathetic system. Emotion, cares, different mental traumatisms and above all defective food, too rich in indigestible substances in our sedentary habits, cause soon hepato-biliary insufficiency. Hypercholesterinemia which predisposes to formation of gall stones is seen extraordinarily frequent in all dyspeptics, plethorics, hereditary or acquired arthritics.
Infection causes later on by ascending passage or by descending passage, through blood particularly in case of Eberth’s bacillus or paratyphic bacillus.
The evolution is variable. Very often cholecystitis exists alone but choledocitis may be associated; rarely there is angiocholitis with infection causing lesions up to the interior of the liver in and around the bile ducts. There are angiocholecystitis or chronic cholecystitis which may be subacute, evolving towards atrophic sclerosis of the bladder. Its evolution is slow, the temperature does not exceed 38 or 38.5. There are also some acute suppurated cholecystitis with puffiness of the hypochondria and vascular plastron. Finally there are over-acute or gangrenous forms which may suddenly show in the form of very grave generalised peritonitis.
In case of these last two cases of acute or gangrenous cholecystitis immediate surgical recourse is to be taken. The homoeopathic remedies should yield its place to surgery or should be used as secondary treatment before and after the operation. But very often we will speak specially of it. What should be their therapeutics.
D–Search for a Rational Therapeutic of cholecystitis In official medicine the dilemma is : should be operated or not? When one should operate? If the disease seems to be cured by itself in time and with much patience, regimen, rest and some therapeutic trials, one should think that it is fortunate to have such a result thanks to the chance of the patient and in such a case the doctor does not merit the result because the treatment is neither audacious nor complicated : Absolute rest, application of ice, diet which must be strict and which can cause rapid emaciation, prescriptions of some chemicals as medicine, that pretend to modify the intestinal content or disinfect it.
More rational is the use of cholagogs, when the content of the bile allows it. Because, in fact, it may be dangerous to mobilise the gall stone more or less voluminous by a brutal drive of the bile from liver to intestines. On this matter it is interesting to recall the trials that have been done to valorise and classify different eliminatory substance or substances forming bile. It is necessary to distinguish with Brugsch and Horster, the property called Cholagogs and Choleretics. The cholagogs only eliminate the bile content in the extrahepatic bile duct and in the bladder. They are Magnesium Sulphuricum, Peptone, Olive Oil, Yellow of the Egg, Milk and even Simple Water and wine, finally Vichy water, water of Carlsbad and of Chatilguyon, But almost all the substances have value as preventives, only to check the cholecystitis.
In the biliary infection, in the developed stage, their use is dangerous.
The choleretics directly increases the flow of the bile secretion not only in the liver, but within the tissues, on the surface of the interstitial lymphs and lacunary system. We may divide them in 5 groups (Charbol)
The Aromatic Group. Which corresponds to Atophan, Naphtolate and Oxynaphtolate of sodium or potassium, Biliary salts. Very active choleretics may be included in this group but not used in Homoeopathy.
The Fat Group. Oil of Haarlem, Oleic acids and Oleates, double product of oil and chloralose.
The Diastasic Group. Secretine, Histamin and possibly Insulin.
The Mineral Group. Sodium sulphate and Magnesium chloride, Calomel, the action is disputable and not well known. Nephtal, a new diuretic, is dangerous and rapidly toxic, having a mercury base.
The Vegetable Group. The bark of alder, root of Eupatorium, Rhizopoda, flowers of Rosemary and of Artichaks, flowers and roots of Chicorea, Aloe, Rhubarb, Cascara, Boldo, Mentha, Podophyllum.
It is interesting to note here the scientific confirmation of our homoeopathic remedies such as Eupatorium perf., Taraxacum, Aloe, Rheum, Podophyllum, in the vegetable group; Natrum sulphuricum, Magnesia muriatica, Mercurius dulcis (Calomel) in the mineral group. Compare also in the group of bile salts and in the oil group : Calculi biliaris, Fel tauri. As preventive the mineral waters may give good effect but they may be dangerous when the cholecystitis is confirmed.
Hepato-biliary organotherapy should not be neglected. To homoeopaths also it may give good help as Barishac and Martiny use it.
Pancreatic optotherapy should not be neglected according to the gravity of hepatic troubles and lesions of pancreas co-existing with cholecystitis.
In spite of these different medicines, the doctor has often no arm against an infection, increasing slowly and rapidly, of the gall bladder and specially if the fever rises, if the pain increases, if the contraction of the abdominal wall in the region of hypochondria persists, if the nausea augments, if there is the danger of icterus or sub-icterus and finally if X-ray plates show one or many stones, surgical intervention is necessary but even then there is risk.
It is necessary to avoid the ablation of the gall bladder and try to cure medically and if such a result is not possible, the surgeon will try to do only cholecystostomy which is always preferable to cholecystectomy.
5. Cholecystitis. Therapeutic plan.
1. Biliary drainage. Cholagogs and choleretics.
Lower dilutions of Solidago, Carduus Marianus Berberis Podophyllum, Taraxacum, Hydrastis.
Decoctions of Taraxacum, Artichaks (leaves), Rosemary (leaves) wild Chicori (leaves), Boldo, Podophyllum.
Ponderable doses of Magnesia sulphurica, Magnesia muriatica.
Haarlem oil (small doses at long intervals)
Olive oil, biliary salts
Mineral waters (with care)
1. Homoeopathic remedies properly called.
(a) External Liver. Compress imbibed with mother tinctures of Chelidonium, Berberis, Carduus marianus, Bryonia, Chionanthus, Colocynthis, Chamomilla, Dioscoria, China, Myrica.
(b) Internal Liver. Pain Colocynthis Bryonia Dioscorea Magnesia Phosphorica.
Infection : Baptisia, Gelsemium, Eupatorium Perf, China, Arsenicum album, Echinacea.
The homoeopathic remedies indicated in the fever of cholecystitis are often the same as that of intermittent fevers because of the similarity of the temperature curve in both the cases, besides analogous clinical pictures.
Hepato-biliary insufficiency (Use the ground remedies) Ricinus communis, Cocculus, Nux vomica, Ipecac.
The Mercuries. Vipera, Anacardium, China, Chelidonium, Myrica, Chionanthus, Ptelia, Kali carbonicum, Juglans cinerea.
Ground remedies (or remedies of morbid temperament).
Phosphorus, very often
Arsenicum Album, Lachesis Lycopodium (with great care)
Natrum Sulphuricum, very often.
Rarely Graphites, Ignatia, Nux Vomica, Natrum Muriaticum, Sepia, Sulphur, Psorinum, Aurum Metallicum, Silicea Calcarea Carbonica.
3. Isopathic Remedies and Nosodes.
Cholesterinum (200, 1000, 10,000)
Lecithin, Lutein (high dilutions)
Individual blood isopathy, stools or urines.
4. Organotherapy. Three types of prescriptions :
—Substitutive organotherapy. Ponderable doses.
—Excitant organotherapy. Lower triturations or medium dilutions.
—Regulatory organotherapy. High dilutions (100-10,000)
Extracts of liver, pancreas, ovaries, spleen, kidney, biliary calculus.
Two failures, about 8 years ago after habitual homoeopathic treatment led me to think about the question of drainage. I was not content to use different other remedies which are not classic. I wanted at first to obtain a good drainage of the bile in my patients. Homoeopathic organotherapy, particularly Fel tauri and Bilis in the 3rd and 6th dilutions appeared to me to act though in an inconstant manner. Among the organotherapic remedies the specialised products called proxitasis seemed to me to have interesting action. But it was not sufficient. Haarlem oil seemed to me more satisfactory. This is a secret product of Holland of the 16th century, always used, contain different plants mixed with the essence of Terebinthina and Sulphur. I still use this compound. A good remedy of drainage is also Magnesia sulphurica;but it should be used in Allopathic doses as for example a tea spoonful every week. In this way colics in case of simple cholecystitis may be prevented.
In homoeopathy we know already as remedies of drainage Solidago virga and Carduus marianus. But these remedies are very little effective in confirmed cholecystitis. The theory of drainage formulated by Dr. A. Nebel of Lausanne which leads specially to the treatment of cases of bile and cholesterin retention, has some deductive value in therapeutics. Let us recall the action of Carduus on the left lobe of the liver, its constipation of frothy stools, difficult and hard, its tendency to jaundice, with dark pigmentation on the skin; its evolution towards cholecystitis and pigmentary cirrhosis or ascites, its pre-cancer state. We should knew that the pain of Solidago is localised on the kidneys in the J. L. Petit’s triangle or in the costo-vertebral angle, its rare urines which are thick, with thick and red-brick deposits; its saburral tongue and the bitter taste in the mouth.
The decoction of Boldo may be used as a drainage remedy or one may use the plant in low dilutions but its actions is inconstant and very slight. Boldo seems to act always in the case of bitter taste in the mouth.
Two homoeopathic remedies which are very important should be mentioned here. Hydrastis and Taraxacum. these remedies are to be given in 3 or 6.
Hydrastis. Acts very slowly. It is a remedy of mucous membranes, specially of those that covers the exterior conduits, with multiple folds. There is on the membranes in question, a thick, viscous and yellowish discharge. It is the ‘thick bile’ of ancient authors. Its habitual symptoms are bitter taste in the mouth, atonic dyspepsia with slow digestion and great weakness, possible jaundice. Pre-cancer stage.