Hepatitis B is a potentially serious form of liver inflammation due to infection by the Hepatitis B virus (HBV) and is one of the most common chronic infectious diseases worldwide. A case of HBV infection in a 50 years old female enrolled for homeopathic treatment is reported here. This case shows the usefulness of homeopathic medicines in giving not only symptomatic relief to the patient but also improving the pathological findings.
Chronic hepatitis B (CHB) is deﬁned as persistence of HBsAg in the circulation for more than 6 months1. At the beginning of the third millennium, Hepatitis B virus (HBV) remains a major public health problem globally; more than two billion people have been infected worldwide, and of these, 350-400 million suffer from chronic infection2, 3. HBV infection can induce a wide spectrum of clinical features, ranging from an inactive carrier state to fulminate hepatitis, cirrhosis, or hepatocellular carcinoma4.
Most patients with chronic Hepatitis B are clinically asymptomatic. Some may have nonspecific symptoms such as fatigue. In most instances, significant clinical symptoms will develop only if liver disease progresses to decompensated cirrhosis. In addition, extrahepatic manifestations may cause symptoms. Accordingly, physical examination will be normal in most instances. In advanced liver disease there may be stigmata of chronic liver disease such as splenomegaly, spider angiomata, Caput medusae, palmar erythema, testicular atrophy, gynecomastia, etc. In patients with decompensated cirrhosis, jaundice, ascites, peripheral edema, and encephalopathy may be present5.
Hepatitis B is diagnosed by detecting one of the viral antigens called hepatitis B surface antigen (HBsAg) in the blood. Later in the acute disease, HBsAg may no longer be present, in which case a test for antibodies to a different antigen hepatitis B core antigen is used. If HBsAg can be detected in the blood for longer than six months, chronic hepatitis B is diagnosed6.
HBV and HDV were transmitted frequently by blood transfusion. Vertical transmission and sexual exposure have become the most frequent routes of HBV infection. Medical procedures still represent a potential source for HBV transmissions and thus strict and careful application of standard hygienic precautions for all medical interventions are absolutely mandatory not only in endemic areas but also in Western countries. This holds true in particular for immunocompromised individuals who are highly susceptible to HBV infection as HBV is characterized by a very high infectivity7.
An increasing number of patients are treated with methods of complementary and alternative medicine (CAM)8. Homeopathy is one of the most widespread and controversial therapies of CAM9 offering a ‘natural’ and effective alternative to conventional medicine, which is overly-dependent on the synthetic remedies of multinational ‘big pharma’10. In spite of widespread acceptance of the merits of CAM within the general public and amongst many medical practitioners, these more controversial treatments have faced sustained opposition from those who advocate an evidence-based approach. Homeopathy, in particular, has been the target of sustained criticism11-15.
The homoeopathic approach is “like should be cured with like”. Although homeopathy seems scientifically implausible, three meta-analyses of controlled trials have found an effect greater than placebo in different diseases16-18. Numerous early attempts have been made to prove the efficacy of ultra-highly diluted homeopathic remedies, but most have not been accepted due to some lacunae in experimental design or for methodological shortcomings, or for some other flaws in the reports19-21. However, Khuda-Bukhsh et al.22-25 proposed a gene-regulatory hypothesis to explain the possible molecular mechanism of action of potentized homeopathic drugs with much circumstantial evidence to support their claim; this also needs to be further validated.
Mrs. S. S. age 50 years, was diagnosed as Hepatitis B +ve in 14 may 2012 by ELISA. On 16 March 2013 she was re-investigated for the detection of HBV-DNA by PCR, and this time it detected HBV DNA. On December 24, 2012, she was consulted for homeopathic treatment of HBV infection.
- Pulsating headache of vertex region from the age of puberty, headache aggravated from cold wind, combing hair and during menses, and improved by wrapping up head with a cloth. (for 37 years)
- Pain epigastric region with sensation of fullness which aggravates after eating. (5 months ago)
- Pain right upper quadrant
- Aching pain in chest with difficult breathing (5 month ago)
- Abdominal pain aggravated after eating followed by loose stool. (5 months ago)
- Pain cervical region with morning stiffness.
- Patient experienced heat flushes in body on and off with heat in palm and soles, and she must uncover them even in winter. (for 2 years)
- Patient was restless and physically weak.
- Generally all symptoms worse by late night-watching or loss of sleep.
History of presenting illness
Patient was alright 37 years ago when she then experienced a headache during puberty. Fifteen years ago she developed a feverish condition and consulted for a medical opinion. Laboratory tests were performed and HBs Ag test was positive. She had climacteric for 2 years. Five months ago she developed chest pain with difficult breathing, abdominal pain with loose stools and was admitted to a hospital. She was diagnosed with Active HBV with an ALT about 57 u/l.
- H/o Hepatitis B, Uterine Fibroid and Heart disease in Mother
- H/o Heart attack in grandfather/Maternal side.
Appetite : Diminished
Thirst : Excessive for cold water
Desires : Spicy food, sweets, cold drinks and foods, ice cream
Bowel Habits : Urging for stool eating after
Urination : Frequent Urging
Perspiration : Profuse
Sleep : Un-refreshing
Thermal reaction : Hot patient
- Red discoloration of palms and nose
- Hypertension 170/100
- HBs Ag by ELISA Method
- HBV DNA by PCR
LABORATORY REPORTS AT ENTRY
- HBs Ag by ELISA Method : Reactive
- HBV DNA by PCR : Detected
- ALT : 57 u/l
ANALYSIS AND EVALUATION OF SYMPTOMS
Anger at trifles
PULSATING, throbbing Headache of Vertex
HEADACHE ameliorates by wrapping up head
HEADACHE from cold air
FULLNESS, sensation of stomach, aggravation eating after
PAIN stomach, eating agg
DISCOLORATION redness of nose
PAIN aching, Chest
PAIN, Liver region
LIVER chronic infection, hepatitis
PAIN Abdomen, aggravation after eating
URGING for stool desire eating after
PAIN cervical region
STIFFNESS cervical region
HEAT foot sole uncovers them
DISCOLORATION redness palm
GOITRE, External Throat
SLEEP loss of, ailments from,
WEAKNESS, enervation, exhaustion, prostration, infirmity in general
HEAT flushes of on and off
DESIRE for sweets
DESIRE for cold water
DESIRE for ice-cream
DESIRE for spices, condiments, piquant, highly seasoned food
Methodology Followed for Selection of Medicine
The medicines were narrowed down by repertorizing all the symptoms, identifying related rubrics with the help of The Complete Repertory and Murphy’s Medical Repertory using the Homeopathic Software Cara Professional. The remedies were chosen based on maximum rubrics and scores using generalities and characteristic particulars of the patient.
Treatment went on for about 3 months. Treatment started on 24-12-2012 with a single dose of Sulphur 200 followed by a single dose of Phosphorus 200. Nux vomica 200, Belladonna 30 and Merc sol 200 needed as complementary remedies.
During the span of treatment the patient was greatly relieved of all symptoms, however mild chest pain and abdominal pain were often experienced. For unspecified chest pain she was referred to a cardiologist. There were no findings indicated a cardiac anomaly. Treatment follow ups showed good recovery of signs and symptoms and laboratory tests improved (which included Non-Detection of HBV RNA and normal range of ALT.)
DISCUSSIONS and CONCLUSIONS
Treatment started from with a single dose of Sulphur 200, which was followed by a dose of Phosphorus 200. It seems that remedies act well if treatment begins with Sulfur in chronic disease, probably due to its anti-psoric properties (as psora is often the underlying cause of chronic diseases). Phosphorus was selected as a constitutional remedy on general characteristics and behavior of the patient and a particular affinity to the gastrointestinal tract and Liver.
The patient responded well to treatment and showed signs of improvement. Her headache, cervical pain and epigastric discomfort was markedly reduced. Her blood pressure was comfortably maintained. She stopped oral hypotensive drugs. Nux vom effectively reduced the abdominal pain and frequent urging for stool. An attack of throbbing headache was ameliorated by a few doses of Belladonna 30. In the last of treatment phase there appeared vesicular eruptions in the oral cavity with over salivation which was relieved by a dose of Merc sol 200. The PCR report for detection of HBV-DNA showed Non-Detection on March 16, 2013. The patient was re-tested for detection of HBV-DNA on December 30. 2013. The tests indicated Non-Detection of HBV-DNA. The usefulness of Phosphorus and Sulphur with associated remedies including Nux-v, Belladonna and Merc sol in the treatment of Hepatitis and associated symptoms mentioned in the literature of homeopathy has been verified and confirmed in the present case. Clinically she has recovered from hepatitis B virus infection at present. The patient may need to be followed up for a longer period to assess any change in the symptomatology and laboratory findings. (See laboratory reports below).
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Overview of the disease
Hepatitis is a general term that means inflammation of the liver. The liver can become inflamed asa result of infection, a disorder of the immune system, or exposure to alcohol, certain medications, toxins,or poisons.Hepatitis B is caused by infection with the hepatitis B virus (HBV). This infection has 2 phases:acute and chronic. Acute (new, short-term) hepatitis B occurs shortly after exposure to the virus. A small number of people develop a very severe, life-threatening form of acute hepatitis called fulminant hepatitis. Chronic (ongoing, long-term) hepatitis B is an infection with HBV that lasts longer than 6months. Once the infection becomes chronic, it may never go away completely.The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person toanother via blood. Semen and saliva, which contain small amounts of blood, also carry the virus. Thevirus can be transmitted whenever any of these bodily fluids come in contact with the broken skin or amucous membrane (in the mouth, genital organs, or rectum) of an uninfected person.Symptoms develop within 30-180 days of exposure to the virus. The symptoms are often compared toflu. Most people think they have flu and never think about having HBV infection.
Feeling tired (fatigue)
Nausea and vomiting
Itching all over the body
Pain over the liver (on the right side of the abdomen, under the lower rib cage)
Jaundice - A condition in which the skin and the whites of the eyes turn yellow in color
Urine becomes dark in color (like cola or tea).
Stools are pale in color (grayish or clay colored).Patients with chronic hepatitis B are at risk of developing liver cancer. The way in which the cancer develops is not fully understood. Symptoms of liver cancer are nonspecific. Patients may have nosymptoms, or they may experience abdominal pain and swelling, an enlarged liver, weight loss, andfever. The most useful diagnostic screening tests for liver cancer are a blood test for a protein producedby the cancer called alpha-fetoprotein and an ultrasound imaging study of the liver. These two tests areused to screen patients with chronic hepatitis B, especially if they have cirrhosis or a family history of liver cancer.Rarely, chronic hepatitis B infection can lead to disorders that affect organs other than the liver. Theseconditions are caused when the normal immune response to hepatitis B mistakenly attacks uninfectedorgans.Among these conditions are:
Polyarteritis nodosa: a disease characterized by inflammation of the small blood vesselsthroughout the body. This condition can cause a wide range of symptoms, including muscleweakness, nerve damage, deep skin ulcers, kidney problems, high blood pressure, unexplainedfevers, and abdominal pain.
Glomerulonephritis: another rare condition, which is inflammation of the small filtering units of thekidney.