CEDH Magazine – JANUARY 2018 - NUMBER 48

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6TH INTERNATIONAL Dopamine and CEDH CONFERENCE Serotonin Barcelona 2017

Predict aging to better manage it

Two neurotransmitters Possibilities of homeopathy in the Anxiety and treatment of Major insomnia Neurocognitive in elderly patients Disorders

Endometriosis

Actaea

racemosa a model of care an update on the management in integrative medicine Materia Medica Addictions

Teaching Clinical Homeopathy

CEDH magazine C O N T I N U I N G M E D I C A L E D U C AT I O N C E D H M A G A Z I N E • J A N U A RY 2 0 1 8 • N U M B E R 4 8

6 International CEDH Conference in Barcelona th

6 & 7 october 2017

2/2

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6 C

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6TH INTERNATIONAL CEDH CONFERENCE

CEDH magazine

BARCELONA 2017

BARCELONA 6 & 7 OCTOBER 2017 (2/2)

48 N°

6 TH INTERNATIONAL CEDH CONFERENCE

4 EDITORIAL ,

Yves Lévêque, MD, 04

5 TWO NEUROTRANSMITTERS: DOPAMINE AND SEROTONIN

Martine Maisonneuve, MD and Aimé Holtzscherer, MD, 05

Published by CEDH, 60 boulevard Diderot, 75012 Paris - www.cedh.org

Editor in Chief: Yves Lévêque, MD Editorial board: Maryvonne Nadaud, MD Frédéric Voirin, MD Contributors for this issue: Aimé Holtzscherer, MD Martine Maisonneuve, MD José Ignacio Torres Jiménez, MD Guy Villano, MD Patrick Vachette, MD Christelle Besnard-Charvet, MD Josette Nouguez, MD Production: Atelier Chalopin, Sérigraphie Translator: Bénédicte Clement Illustrations: Fotolia ISSN: 1950-8832 Legal mention: 0516 T 88691 Publication date: January 2018.

11 POSSIBILITIES OF HOMEOPATHY IN THE TREATMENT OF ANXIET Y AND INSOMNIA

IN ELDERLY PATIENTS José Ignacio Torres Jiménez, MD, 11

23 PREDICT AGING TO BETTER MANAGE IT POSSIBILITIES OF HOMEOPATHY IN THE

TREATMENT OF MAJOR NEUROCOGNITIVE DISORDERS Guy Villano, MD, 23

31 ENDOMETRIOSIS: A MODEL OF CARE MANAGEMENT IN INTEGRATIVE MEDICINE

Christelle Besnard-Charvet, MD, 31

37 ADDICTIONS

Patrick Vachette, MD, 37

Josette Nouguez, MD, 45

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45 ACTAEA RACEMOSA, AN UPDATE ON THE MATERIA MEDICA

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Sharing practices, to improve our knowledge but mostly to improve the health of our patient

BARCELONA 2017

Yves Lévêque, MD Editor in Chief

Y

ou will find in this issue the rest of the articles from the 6th International CEDH

Conference, still in the optic of sharing practices, to improve our knowledge

but mostly to improve the health of our patients and sustain it on the long term:

n Martine Maisonneuve, MD and Aimé Holtzscherer, MD are bringing their knowledge to show us the application in homeopathic therapeutic of Dopamine and Serotonin.

To guide your practice, you will find in this article details on possible prescriptions with the levels of dilution. n Brain aging: José Ignacio Torres Jiménez, MD shares his deep knowledge and approach of the elderly persons (a person who has a certain age as underlined by Professor Jeandel), specifically in the implementation of a treatment taking into account the drawbacks of classic treatments (often noxious or triggering side effects in elderly patients). n The article by Guy Villano, MD: Predicting aging to better manage it, focuses on the “possibilities of homeopathy in the treatment of major neurocognitive disorders”.

Based on a simple and exhaustive presentation of all these disorders we bring evidence that homeopathy is highly relevant in this field. n Christelle Besnard-Charvet, MD presents endometriosis in a concise, clear and comprehensive way including the “conventional” approach and the homeopathic process for a global management.

The article on addictions gives a testimonial to the psycho-behavioral approach,

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experience and practice of Patrick Vachette, MD. He highlights the relevance

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of considering the Sensitive type. n To conclude the medicine Actea racemosa presented by Josette Nouguez, MD gives us a documented article full of medication relationships. This shows the relevance of a differential diagnosis to determine the medicine and thus the need to really know the Materia Medica. n

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Two neurotransmitters: 6TH INTERNATIONAL CEDH CONFERENCE

Dopamine and Serotonin

BARCELONA 2017

Aimé Holtzscherer, MD - France Martine Maisonneuve, MD - France

N

eurotransmitters (there are more than 60 of them) are chemical components synthesized in the cytoplasm of neurons’ presynaptic endings (sometimes also in the glial cells) They are stocked in the neurotransmitter vesicles.

When an action potential occurs, the content of these vesicles is released

(1,000 to 2,000 molecules) in the synaptic cleft. From there, the molecules are partly captured by the receptors of the post-synaptic cell. About 80% of the released molecules are re-captured by the pre-synaptic neurons.The neurotransmitter degradation is observed either in the synaptic cleft or within the neuron. In some cases, dopamine and serotonin can act in a complementary manner and in other cases in an antagonist manner.

DOPAMINE

IN THE CENTRAL NERVOUS SYSTEM, dopamine plays a complex role and acts in several important functions:

This neurotransmitter belongs to the catecholamine family and thus stemming from the tyrosine amino acid.

Tyroxine >>> L-DOPA >>> Dopamine TH DDC

HO

NH2

CH2

TH: Tyrosine oxydase DDC: DOPA Decarboxylase

SERUM CONCENTRATION: 0.01 picogram/l = 10-14, thus up to 7 CH we have a physiological action.

DOPAMINE HAS VARIOUS MAJOR TARGETS in the various brain structures belonging to the basal ganglia system: • Striatum, • Globus pallidus, • Subthalamus nucleus.

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HO

CH

• behavior, • cognition, • motor function, • motivation, • reward, • sleep, • memorization, • migraine, • awareness.

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Two neurotransmitters: Dopamine and Serotonin

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And also: • Hippocampus, • Hypothalamus, • Cerebral cortex.

There three major ascending pathways of the mesencephalon (midbrain): the nigrostriatal pathway, the mesolimbic pathway and the mesocortical pathway.

• Decreased of renal reabsorption of sodium (Na) (D2).

• Decrease release of renin and aldosterone.

Nervous system pars compacta >>> Striatum dorsal (consisting of the caudate nucleus and putamen)

• Inhibits intestinal motility.

This network acts in the control of motor function (Parkinson’s disease is due to a degeneration of a group of neurons producing dopamine in the substantia negra).

The symptoms of Parkinson’s disease are caused, a least partially, by an increased activity of the cholinergic neurons due to deficient dopaminergic neurons.

2. THE MESOLIMBIC PATHWAY Mesencephalon>>> limbic system Dopaminergic neurons of the ventral tegmental area (VTA) of the midbrain have for target the ventral striatum (accumbens nucleus, stria terminalis, olfactory tubercle, septum, amygdala, and hippocampus).

This network represents the D3 receptors system of reward/reinforcement involved in addictions and dependence (cocaine, nicotine, amphetamines, alcohol and opioids) and emotions.

This pathway is involved in the brain area responsible for the gag reflex.

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• Renal vasodilatation (maintaining a diuresis) - mesenteric, - coronary, - brain, - increased heartbeat.

1. THE NIGROSTRIATAL PATHWAY

It makes up for 80% of the central dopaminergic neurons (receptors D1 and D2).

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AT THE PERIPHERAL LEVEL, dopamine has a role of Circulatory analeptic (D1 receptor):

3. MESOCORTICAL PATHWAY VTA >>> Frontal and temporal D1 and D4 receptors Role in concentration and executive functions, like work memory.

• Exercise increases the natural production of dopamine. This explains the addiction to sports in professional athletes.

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Dopamine insufficiency • Parkinson’s disease, • Erectile dysfunction, • Restless leg syndrome, • ADHD, • Depressive states.

- Apomorphine activates the D1 and D2 receptors, which is indicated in Parkinson’s disease and erectile dysfunction.

- Tricyclic antidepressants act on the catecholamine receptors.

- Monoamine oxidase inhibitors (MAOIs) act on the synaptic degradation of dopamine, thus indicated for fibromyalgia.

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Excess dopamine • Dependence/addiction, • Psychosis (D1 and D2), • Sleep disorders with hypervigilance, • Decreased emotions D3,

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Two neurotransmitters: Dopamine and Serotonin

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• Obsessive Compulsive Disorders (OCD), • Migraines with vomiting, • Fibromyalgia, • Anorexia, • Logorrhea.

SEROTONIN

• Sulpiride is: - D2 dopamine receptor agonist, - D3 dopamine receptor antagonist.

Tryptophane >>> 5HTP >>> Serotonin TH 5HTPD

This neurotransmitter is a tryptophan amino acid derivate.

• Increased vigilance.

DOPAMINE IS ALSO A HYPOTHALAMIC HORMONE:

PRL TSH

DOPAMINE FSH LH

Its main role is to inhibit prolactin-like hormone and secondary roles to inhibit TSH, FSH and LH.

5HTT: 5 hydroxyphane TH: Tryptophan oxidase 5 HTPD: 5 Hydroxytryptophan-dehydrogenase

SERUM CONCENTRATION: 0.1 to 0.3 picogram/l = 10-6 Physiological action up to 6 CH • The serotoninergic activity of a molecule remains essential but in order to be effective it must also have a noradrenergic and dopaminergic dimension.

Estrogens lead to a significant increase of serotoninergic receptors.

CLINICAL INDICATIONS n STIMULATION OF THE MILK PRODUCTION:

15 CH 5 pellets, twice a day (personal observations).

In the following indications, Dopamine in 15 CH was always prescribed with complementary homeopathic medicines:

• In the digestive tract, part of the serotonin goes into the blood where it is stored in platelets. In the first part of coagulation, when platelets aggregate, they release serotonin that will lead to vasoconstriction. It is also stored in the mastocytes, lymphocytes, macrophages, etc. and participates to immediate hypersensitivity.

• In the Central Nervous System (CNS), the cellular body of serotoninergic neurons is located in the raphe nuclei of the brain stem. Neurons that project to the entire brain and the spinal cord.

inhibiting action on FSH, n IMPOTENCE for its inhibiting action on LH, n HYPERTHYROIDISM for its action on TSH.

• The effects of serotonin on the other neurons can be inhibiting or exciting according to the nature of the receptors.

• It is the precursor of melatonin.

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n LOW FERTILITY in men and women for its

• It is produced at 80% in the intestinal mucosa where it is synthesized and stored in chromaffin cells.

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(Exposition to sunlight prevent the transformation of serotonin into melatonin).

• We know of at least 14 genes coding these serotoninergic receptors classified in seven groups.

SEROTONIN HAS A ROLE IN: • Thermoregulation, • Eating behaviors (increased), • Sexual behaviors (decreased sex drive), • Wake/sleep cycle (diminution or disruption), • Pain (increase),

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Serotonin increase • Bulimia: hyperphagia, • Decreased sex drive in men and women, • Disrupted sleep, • Migraines with no vomiting, • OCD, • Fibromyalgia, • Raynaud’s disease (the alkaloid from ergot, Secale Cornutum, is close to serotonin).

SEROTONIN-MIMICKING AGENTS LEAD TO: • Mood (depression), Selective serotonin reuptake inhibitors (SSRIs), like Fluoxetine, improve depression.

• Motor control, • Intestinal peristalsis, • Cognition, • Emotional states, • Migraine, • Raynaud’s disease, • OCD (increased), • Fibromyalgia, • Hot flashes: in case of intestinal carcinoma, • Palpitations, • Irritability, • Impatience, • Aggressiveness, • Insomnia: disrupted sleep.

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A serotonin imbalance could explain, in 50% of cases, sudden infant death syndrome.

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Serotonin insufficiency

• Confusional or manic state, • Myoclonus, hypertonicity, hyperreflexia, constantly moving, lack of coordination, • Tremors, • High blood pressure, • Diarrhea, • Hyperthermia, • Anorexia.

BEHAVIORAL EFFECTS OF HALLUCINOGENIC DRUGS, like LSD, psilocybin or mescaline are

related to the activation of certain serotoninergic receptors.

ECSTASY increases greatly the serotonin production in a temporary manner followed by a sustainable 50 to 80% serotonin deficit.

EXERCISE increases serotonin.

MESCALINE, alkaloid of a Mexican cactus acts like an agonist on the serotonin receptors and leads to: • Euphoria, • Visual and auditory hallucinations, • Concentration disorders, • Disorientation.

PSILOCYBIN, alkaloid from a mushroom, leads to:

• Irritability, • Impatience: always in a hurry, • Aggressiveness, • Depression.

• OCD, • Vascular facial pain, • Euphoria.

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Two neurotransmitters: Dopamine and Serotonin

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LSD: derivate from ergot leading to a massive release of serotonin in the brain.

• Psychostimulant leading to hallucinations.

n SLEEP:

POTENTIAL USES IN HOMEOPATHY

n FIBROMYALGIA:

• Serotoninum muriaticum 15 CH if the sleep is disrupted + Dopamine 15 CH if there is hypervigilance.

• Serotoninum muriaticum 15 CH once per day for pain + Dopamine 15 CH once per day for fatigue (personal observations).

n DEPENDENCE/ADDICTION:

n DEPRESSIONS:

• Dopamine 15 CH for the reward/ addiction + • Serotoninum muriaticum 15 CH for weaning from addictions.

start with • Serotoninum muriaticum 5 CH + Dopamine 5 CH once per day.

n VOMITING DURING PREGNANCY:

n MIGRAINES:

• Dopamine 15 CH twice a day (personal observations).

during the attacks: • Serotoninum muriaticum 15 CH migraines without vomiting, twice a day (personal observations) + Dopamine 15 CH if vomiting twice a day.

n ATTENTION DEFICIT DISORDERS

with or without Hyperactivity (ADHD): • Serotoninum muriaticum 15 CH + • Dopamine 6 CH (personal observations). n BULIMIA:

• Serotoninum muriaticum 15 CH. n ANOREXIA:

n RESTLESS LEG SYNDROME:

• Serotoninum muriaticum 15 CH + Dopamine 6 CH, once per day. n OCD:

• Serotoninum muriaticum 15 CH + Dopamine 15 CH, once per day.

• Dopamine 15 CH + • Somatotropin 15 CH (personal observations).

• Serotoninum muriaticum 15 CH, once per day.

n ERECTILE DYSFUNCTION:

n VASCULAR FACIAL PAIN:

• Serotoninum muriaticum 15 CH once a day.

• Serotoninum muriaticum 15 CH several times a day in case of an attack.

n DECREASED SEX DRIVE:

n SLEEP APNEA:

• Serotoninum muriaticum 15 CH + • Dopamine 15 CH.

• Dopamine 15 CH, once at bedtime.

n RAYNAUD’S DISEASE:

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HOMEOPATHIC STRAINS CONTAINING DOPAMINE

• Apis mellifica • Aconitum napellus Medicines of inflammation.

• Coffea sleep, • Dolichos Pruriens, • Urtica urens (Inflammation, urticaria), • Apis mellifica, • Heloderma horridus: Complex Regional Pain Syndrome.

SNAKE VENOMS: • Sepia officinalis: medicine of general action.

HOMEOPATHIC STRAINS CONTAINING SEROTONIN

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• Bufo bufo inflammation of the lymph nodes,

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coagulation and behavioral disorders.

• Venus mercenaria: migraines, • Sepia officinalis, • Murex purpurea, n

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Possibilities of homeopathy in the treatment of EVERY6TH INTERNATIONAL CEDH CONFERENCE DAY BARCELONA 2017

Anxiety and insomnia in elderly patients José Ignacio Torres Jiménez, MD - Spain

“

The real knowledge of the disease is given by an in-depth study of “each case” summing up the disease process but also the possible variations.

Gregorio Marañón

1

”

The elderly person

1. CLINICAL: associated pathologies, polypharmacy, hospitalizations, recurrent falls, sensory impairments, incontinence.

THE FRAIL PERSON

2. FUNCTIONAL: dependence for basic activities and activities of daily living.

Frail persons 1, 2, 3 present with a decrease of the physiological reserves of multiple systems in the body and are at a major risk of degradation, putting them in a vulnerable situation when facing external disruptors. There is an important probability to have healthcare disorders (e.g. hospitalization, institutionalization, death, falls) as well as a loss of functions, disability or dependence.

There is a continuity between the physiological, the functional and the pathological, from the absence of physiological frailty to the presence of clinical frailty and later the development of disability and dependence.

Generally, frailty sets it in a progressive manner.

Different factors condition this frailty 6 and we can divide them into different categories:

4. EMOTIONAL AND COGNITIVE: depression, cognitive impairments.

THE ELDERLY PATIENT: A REALITY IN OUR CONSULTATIONS From standard care to personalized prevention Elderly patients require our care and attention.

This attention needs to deviate from a standard care strategy 7, 8 – often created by directors, politicians, or even healthcare professional – and be directed for these persons 9, who are often elderly or very elderly and who value more tenderness, respect and nursing than the technique, and who generally accept, and without critics, any recommendation that might help them.

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The severity of frailty 3, 4, 5 varies according to the criteria considered. These can range from 5% to 58% in elderly persons and increase with age independently of the method used to assess frailty.

3. SOCIOECONOMICS: recently widowed, solitude and isolation, placement in a nursing home, poverty, > 80 years.

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For elderly persons who come to our medical offices, it is essential to have space and time especially when the decisions are complex because of motor, sensory and cognitive difficulties of these patients. A space for listening and discussing with our patients. A shared moment.

5. In principle, these patients need very few pharmacological medications and their state generally improves considerably when we discard the dangerous or unnecessary medicines like statins, hypotensive or psychotropic drugs.

Focus on care, on primum non nocere (first do no harm) as a basic principle while considering – when possible – to avoid prescription drugs and reinforcing ties to the community and non-pharmacological interventions to avoid the high frequency of inadequate prescription treatments 10 , which are the case for over 50% of these patients.

6. We should never forget that in these elderly persons, the reaction to prescription drugs is unpredictable.

Our daily work consists in listening, being with them in our medical office and in their home and sharing their preoccupations and problems. It helps us taking into considerations their real needs, what they want or not.

Many of these persons are sunshiners 11 as described

by John Sloan.

One of the biggest issue in elderly persons is polypharmacy 12 defined as the simultaneous take of several prescription drugs (the more medicines the higher the probability of negative consequences on the patient’s health). This correlation seems even more potent when we go over five medicines, but it can also be defined by the use of not-indicated or inappropriate prescription drugs, independently of their number.

Persons near the end of their life, who need help to perform activities of daily living, who do not want to be a burden, who have difficulties moving around, cognitive disorders or even both, more preoccupied by their quality of life than time left to live, who are taking too many medicines and want to avoid hospitalization.

WHEN ENVISIONING A PHARMACOLOGICAL TREATMENT, ONE SHOULD TAKE INTO ACCOUNT AT LEAST THESE SIX POINTS 11

1. Frail patients are all different. The approach must be completely individualized.

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2. They are not just different as individuals, but also very different compared to younger patients. This is why decisions taken regarding examinations done in younger patients are hardly applicable to these older patients.

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3. This is why deciding what medicine will be useful in a frail individual is not just a question solved in Best Clinical Practices Guides or protocols but rather by individualized care, caution and common sense, often rarely used when assisting these patients.

4. To prescribe, one should not just take into account the numbers (glucose level, blood pressure, cholesterol) or diagnoses, but rather wonder if such and such medicine will improve the function or comfort of this particular person.

THE ISSUES OF TODAY’S MEDICINE IN ELDERLY PERSONS

In our country, the prevalence of polypharmacy is around 50% in older persons over the age of 65, 70% for frail older people or very elderly persons. The use of inappropriate medicines is also very common (34%). It is an every growing phenomenon, with clinical, legal, ethical, social, economic consequences as well as a being a Public Health concern.

Iatrogeny 13, 14, 15 has become a major Health Public concern in industrialized countries because of the risks of mortality and morbidity that it generates.

Other important problems in an elderly population concern the diagnosis and treatment 18-23 of common healthcare disorders: this is at the origin of additional examinations and prescription drugs that are unnecessary and thus potentially harmful.

HOMEOPATHIC MEDICINES IN THE ELDERLY PATIENT a return to personalized medicine Homeopathic medicines in chronic patient present a special relevance because of their

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… anxiety and insomnia in elderly patients

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lack of noxious interactions, their safety and effectiveness in long-term symptomatic treatments for physical and psychological disorders but also thanks to the possibility of establishing a relationship through the clinical interview allowing each patient to feel that he or she is treated as a person.

GENERALLY, TO BE ABLE TO ESTABLISH A DIAGNOSIS 25, THE PHYSICIAN TAKES INTO ACCOUNT

ANXIETY IN THE ELDERLY PERSONS

• The presence or absence of an objective stimulus at the origin of the anxiety.

• The intensity of the emotional expression (adapted or maladapted to the stimulus).

• The proportional or disproportionate duration overtime and the interference or not of daily life symptoms.

Today, anxiety is a very common health problem. So frequent that about 50% of patients who consult 24, 25 present with anxiety symptoms.

In elderly patients, anxious disorders are common and generally unveiled by an atypical and multi-symptomatic clinical picture. The predominant symptoms are somatic ones and often are attitude symptoms or obvious behaviors with hyperactivity and worry.

We can define anxiety by the fact of anticipating an imminent disease or doom associated with a feeling of dysphoria (unpleasant) and/or somatic high blood pressure disorders 25.

Identifying the presence of a pathological anxious state is not an easy task. We looked at different means to establish the diagnosis of these healthcare issues in the most specific manner and for more than 50 years we have used the Diagnostic and statistical manual of mental disorders (DSM) from the American Psychiatric Association.

Memory disorders Cognitive deterioration

Sedation Confusion Lack of coordination / Ataxia Falls

Graph 1. Frequent side effects of psychotropic drugs

The difficulty to treat is greater in these persons because of: • The important vulnerability to side effects (graph 1), • The possible degradation of the renal and hepatic functions in relation to their previous disease, • Polypharmacy.

Metabolic Glucose lipids Prolactine weight hyponatremia

Side effects of psychotropic drugs

Blood pressure Cardiac system

Anticholinergic drugs

Extrapyramidal effects

Epilepsy Lowered seizure threshold

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Abstinence – Dependence Rebound effect Paradoxical reaction

The presence of physical and psychological comorbidities is very common (depression in 50 % of cases) and is generally related to major psychosocial changes: widowhood, retirement, loss of autonomy, cognitive deterioration…

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Homeopathic treatment of anxiety disorders in elderly persons

4. INFIDELITY: Natrum muriaticum, 5. FRUSTRATION: Staphysagria, 6. JEALOUSY: Lachesis mutus, Pulsatilla, 7. DESPAIR: Aurum metallicum, Arsenicum album,

In the care management of anxiety in elderly persons, we have several treatment pathways at our disposal thanks to homeopathic medicines.

1. Etiology medicines,

8. FEAR OF DISEASES: Arsenicum album, Thuya occidentalis, 9. LOSING THE MEANING OF LIFE: Aurum metallicum, Sepia officinalis.

2. Symptomatic medicines: medication for somatic disorders, worry and agitation, 3. Medicines of the Chronic Reactional Mode,

SYMPTOMATIC MEDICINES OF ANXIETY IN ELDERLY PERSONS

4. Medicines of the Sensitive Type, 5. One needs to frequently take into account medicines of depression in the association of this problem and anxiety in elderly persons.

ETIOLOGY MEDICINES FOR ANXIETY IN ELDERLY PERSONS When deciding on the treatment for anxiety disorders in elderly persons, one needs to take into account the Individual Reaction of the Patient faced with a stressful situation and expression of the feelings and emotions predominant in a context of communication centered on the patient 26.

In this context, evaluating the cause of the problem, according to the clinical story and importance that the patient gives it, is essential when planning for an adequate treatment.

SOME OF THE MAIN MEDICINES 27 TO TAKE INTO ACCOUNT

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ACCORDING TO THE ETIOLOGICAL CIRCUMSTANCES ARE

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THE MAIN SYMPTOMATIC MEDICINES OF ANXIETY ARE RELATED TO SOMATIZATION 27, which is very important in elderly persons and conditions their quality of life.

We can valorize the use of symptomatic medicines according to the individual reaction of the patient getting sick and classify them in an academic manner into medicines of:

• AGITATION Aconitum, Argentum nitricum, Lilium tigrium or Medorrhinum, • INTROVERSION Ambra grisea, Gelsemium, Pulsatilla, Sepia officinalis or Thuya occidentalis, • SPASM Nux vomica, Ignatia amara and Moschus and • ALTERNATION OF PSYCHOLOGICAL BEHAVIORS Actaea racemosa, Arsenicum album, Aurum metallicum, Causticum, Lachesis mutus, Lycopodium clavatum, Natrum muriaticum, Platina, Phosphorus and Tuberculinum.

1. LOSS, ABANDONMENT: Ignatia amara, Natrum muriaticum, Pulsatilla and Actaea racemosa, 2. GRIEF: Ignatia amara, Natrum muriaticum, Phosphoricum acidum, Arsenicum album, 3. FAULT: Aurum metallicum, Causticum, Medorrhinum,

ANXIETY AND SPASM The first medicine to consider is Ignatia amara with its sensation of oppression and spasms at

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“

Today, anxiety is a very common health problem. So frequent that about 50% of patients who consult present with anxiety symptoms.“

digestive and pharyngeal level, variability in the enthusiasms and usual modalities of improvement by distraction and aggravation by contradiction.

Other close medicines are Moschus with a tendency to get dizzy, Kalium carbonicum with epigastric anxiety and intolerance to touch, as well as its timetable modality with an aggravation from 2 to 4 am and Asa foetida with the sensation of a lump that comes up via the esophagus.

At a digestive level, we also retain the importance of Lycopodium clavatum with its characteristics symptoms of dyspepsia after meals, Nux vomica spasmodic and irritable, who gets improved after a short nap, Pulsatilla with its variability and intolerance to fatty foods triggering multiple digestive symptoms, Staphysagria with somatic disorders for her frustration and Sepia officinalis with digestive disorders and gastric ptosis.

WE ALSO HAVE OTHER MEDICINES FOR SOMATIZATION AND PAIN

• Platina: spasmodic with a sensation of compression, • Causticum with stiffness and retraction improved by a damp weather, • Nux vomica spasmodic with hyperesthesia, • Chamomilla vulgaris when pain is even more unbearable with a sensation of numbness, • Magnesia phosphorica, neuralgia, contractures and spasms, • and Gelsemium as a muscle relaxant medicine just like Arnica montana, Bryonia alba or Rhus toxicodendron without forgetting a very frequent painful somatization of repressed anger for Staphysagria.

ANXIETY AND FATIGUE – HEADACHES – INTELLECTUAL DISORDERS

ANXIETY AND PAIN Phosphoric medicines with the alternating bipolar nature of Phosphorus, effort headache and psychophysical fatigue of Kalium phosphoricum and emotional and mental exertions of Phosphoricum acidum are especially useful in patients with psychasthenia (from the Greek psyche, “liveliness” and asthenia “weakness”) in whom phobias, obsessions, anxiety, apathy, feeling of being bizarre in relation

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On a muscular level, Actaea racemosa has a special importance: medicine with a sudden neck pain, brachial neuralgia, and posture pain with sensitivity on the spine from T4 to T6 in a context of poor posture, alternation of muteness and logorrhea as well as preoccupations.

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to the rest of the world or oneself and intellectual and social inhibition predominate.

TYPE OF PREDOMINANT FEAR, FEAR AND ANXIETY, KNOWING THE ENEMY

Similarly, Anacardium orientale with its indecisiveness and shyness, Causticum fearful, impressionable and memory loss, Zincum metallicum intellectual exertion, weak with restless leg syndrome. These medicines are a great help in a context of senility with sadness, despondency and memory loss.

Fear drives us to extremes, we lose control and our body and mind conjure up disrupting symptoms that prevent us from conducting our daily life in a normal manner because of dizziness, tremors, palpitations, sensation of breathing difficulties, headaches, muscle tension, worries, anxiety, difficulty concentrating, memory loss, irritability, afraid to lose control, afraid of death...

WE CAN ALSO LOOK AT THE CARE MANAGEMENT OF ANXIETY DISORDERS IN ELDERLY PERSONS ACCORDING TO THE TYPE OF ANXIOUS DISORDER EXPERIENCED BY THE PATIENT:

THE MAIN HOMEOPATHIC MEDICINES FOR FEAR 27 • Because of pre-determined causes, • Primary anxiety disorder, • Obsessions, the useful medicines are the following:

ARSENICUM ALBUM is a medicine for patients who take care of themselves, clean, stingy, who are afraid of diseases, future, death.

Their obsessions are generally centered on cleanliness and money.

AURUM METALLICUM is useful in patients with obsessive ideas of death with a tendency to suicide in a context of depression and anger. They lost their power and thus life has no more meaning.

CAUSTICUM is a medicine of physical and psychological regression.

The patient has a feeling of guilt generating a rigid thought process with anxiety and depression, expressed by hyperactivity and anger.

ARE THE FOLLOWING

• FEAR OF DISEASE: Arsenicum album, Kalium carbonicum, Phosphorus and Thuya occidentalis, • FEAR OF SOLITUDE: Argentum nitricum, Arsenicum album, Kalium carbonicum, Phosphorus and Pulsatilla, • FEAR OF BECOMING CRAZY: Sepia officinalis, • FEAR OF DEATH: Aconitum napellus, Argentum nitricum, Arsenicum album, Gelsemium sempervirens, Kalium carbonicum, Phosphorus, Platina and Pulsatilla, • MULTIPLE FEARS: Causticum, Calcarea carbonica, Tuberculinum.

MEDORRHINUM Medorrhinum is useful in agitated and hasty subjects who fear inactivity and thus are unable to stop themselves.

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NATRUM SULFURICUM

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is a good medicine for obese patients who suffer from depression and obsessive ideas. Humidity makes them worse. They have a slow, apathic and indolent nature.

THUYA OCCIDENTALIS is the forefront medicine of obsessions and set ideas for persons who are prone to cenesthesia.

MEDICINES OF THE SENSITIVE TYPE AND CHRONIC REACTIONAL MODE in the treatment of anxiety in elderly persons The 10 main medicines to take into account for chronic treatment of anxiety in elderly persons are:

ARSENICUM ALBUM anxiety, nosophobia, nighttime aggravation, related to physical disease, bankruptcy or loss, frequently associated to depression.

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“

Fear makes us swim quickly to the coast if we see a shark, but it goes away as soon the shark is no longer a threat. Nevertheless, anxiety is fear looking for a motive.”

G. Frazzetto, How do we feel things”

AURUM METALLICUM anxiety, somatization, vascular pathology; anger, depression with suicidal ideas. Context of alcoholism, retirement, bankruptcy, having lost the meaning of life.

CALCAREA CARBONICA slow, emotional, carbonic constitution, fears, pathology related to being overweight, arthritis.

CAUSTICUM stiffness, physical and psychological regression, empathy or anger, feeling of guilt, sensation of imminent doom.

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PULSATILLA variability, shyness, fears. Improves with consolation.

In a context of loss, emptiness, repressed jealousy.

SEPIA OFFICINALIS depression in reaction to a stressful situation, apathy, irritability. Life no longer holds any meaning.

3

Treatment of insomnia in elderly persons

IGNATIA AMARA associated with spasms in a context of loss, grief.

NATRUM MURIATICUM asthenia, mood swings, weak memory.

Etiology: sorrow, infidelity, grief.

Sleep disorders are very common in elderly persons 29 and condition their expectations and quality of life.

The prevalence of sleep disorders in persons > 65 years is from 12 to 40%. “Nighttime awakenings” and “tired when waking up” are the two most common problems.

LACHESIS MUTUS

PHOSPHORUS unstable, asthenic, bipolar, cardiovascular pathology, phosphoric constitution, sensitive.

Etiology: stress or grief.

When one studies sleep disorders, we should take into account the nature of the disorder by refining the sleep/wake cycle, evolution time, possible triggers (disease, stressful vital factors, and medicines), health and disease habits and relevant parameters such as the total sleep duration, sleep effectiveness, time required to fall asleep and wakeup time after conciliate sleep.

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anxiety, cardiovascular pathology, logorrhea or depression. In a context of alcoholism, loss or jealousy.

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INSOMNIA TREATMENT Benzodiazepines (BZD) are one of the drug classes most prescribed in industrialized countries and their prescription has dramatically increased in these past year in Spain (far greater than in other European countries). They are addictive medicines, and in longterm treatments some issues can arise like tolerance, dependence, abuse on top of side effects like memory loss, loss of reflexes, confusion and a greater risk of falls and fractures, it can even lead to dementia 30.

The elderly population is the group most vulnerable to the prescription of benzodiazepines. This is why this drug class is included in high-risk medicines in elderly persons and in Beers criteria 31. Furthermore, one of the STOPP-START criteria 32 underlines not to use BZD for more than 4 weeks.

HOMEOPATHIC TREATMENT OF INSOMNIA IN ELDERLY PERSONS When one considers the treatment of sleep disorders in elderly persons, it is important to take into account the etiology, at what time of night these sleep disorders appear and the evolution time.

helpful to determine the symptomatic medicine and, in chronic cases, the physician will need to study the Sensitive Type medicine and the Chronic Reactional Medicine.

INITIAL INSOMNIA THE MAIN MEDICINES ARE

COFFEA CRUDA excessive mental activity and agitation, palpitations, tremors following generally positive emotions.

AMBRA GRISEA characteristic insomnia when sleep disappears when falling asleep. In a context of shyness, low self-esteem and being hyper emotional.

GELSEMIUM SEMPERVIRENS ARGENTUM NITRICUM present with insomnia when falling asleep due to anticipation fear with respectively a blockage (important presence of a previous emotional shock) and hastiness.

ARNICA MONTANA

ETIOLOGY It is essential when we will consider the most appropriate medicine for transient or short-term insomnia.

THUS

COFFEA CRUDA insomnia with a hard time falling asleep due to positive emotions.

GELSEMIUM SEMPERVIRENS ARGENTUM NITRICUM insomnia due to the fear of anticipation.

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nighttime awakening because of suppressed rage.

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NUX VOMICA

when he can’t find sleep following physical effort with muscle exhaustion and muscle aches and:

ZINCUM METALLICUM when the exertion is nervous or in a context of restless leg syndrome.

Intellectual exhaustion and sleepwalking will point to:

KALIUM PHOSPHORICUM Grief, sorrow and worries mixed with symptoms of spasmodic somatization, point towards:

IGNATIA AMARA NATRUM MURIATICUM when there is an emotional stress, a feeling of abandonment or infidelity and when sleep never feels enough.

insomnia following intellectual and professional exhaustion.

NIGHTTIME AWAKENING

In short-term sleep disorders, the analysis of the Individual Reaction of the Patient (IRP) will be very

We have several medicines to treat nighttime awakening.

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MEDICINES OF NIGHTTIME AWAKENING WITH FEAR AND/OR ANXIETY

LUESINUM

Nighttime awakening with intense agitation:

ACONITUM NAPELLUS for fear of dying as a consequences of all the fears experienced by the patient.

HYOSCIAMUS STRAMONIUM KALIUM BROMATUM

4

for nightmares and night terrors.

NUX VOMICA is the medicine for the mentally and physically exhausted white collar worker waking up at 3 am.

STAPHYSAGRIA following humiliation and vexation also present in a clinical picture of insomnia with nighttime awakenings.

MEDICINES FOR NIGHTTIME AWAKENING WITH PREOCCUPATIONS, BROODING OR PAIN Unbearable pain, cause of insomnia at any age is typical of

CHAMOMILLA VULGARIS It is the same when the sleep disorder is a consequence of anger or punishment.

SILICEA is useful in weak and exhausted persons who present with emotional deprivation.

ARSENICUM ALBUM must be used when the awakening occurs at dawn, and the elderly person feels very bad and is afraid of getting sick or dying.

OPIUM

LACHESIS MUTUS must be prescribed in patients who have nightmares and see dead people in a context of grief or jealousy with a suffocating oppression.

Conclusion THE ADVANTAGES OF HOMEOPATHY AS AN ALTERNATIVE in the treatment of anxiety and insomnia in elderly persons The two main advantages of these homeopathic medicines in patients presenting with anxiety and insomnia disorders are: safety and effectiveness 36-39 THEY ARE IDEAL THANKS TO THEIR EFFECTIVENESS IN 1. Stressful situations generating anxiety, which are frequent reasons for consultation in primary care, and that usually do not need psychotropics and/or psychotherapy because of their transient nature, their lightness or specificity. For example, reactional anxiety when faced with bad news, fear of traveling; 2. When there is a specific risk of side effects in respiratory, renal or hepatic pathology with multiple treatments, which is quite usual in elderly patients; 3. Long-term treatments because of their safety and the absence of dependence. Furthermore, they can be given as a complement to the usual treatment to decrease the need of a “co-prescription” of anxiolytics or increased dose of psychotropics because they decrease their potential side effects. Consequently, they will help adjust the dose to minimize the adverse effects.

4. “De-prescription” of psychotropics: the prescription of homeopathic medicines contributes at first to reduce their prescription and secondly to become a relay of classic medicine.

The removal of BZD40-42 is beneficial for elderly patients; it improves cognitive and psychomotor aspects with some discomfort, but it cannot be done too quickly because of the addiction syndrome.

The percentage of BZD weaning varies between 25 and 85 % and any help to the patient (therapeutic, psychological…) is useful.

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is a good medicine for patients with sleep apnea, sleepwalking, paralyzed by fear of auditory hypersensitivity (cannot sleep if there is the slightest noise).

is the main medicine to treat total insomnia, especially in patients with obsessive disorders for cleaning and a constant need to wash their hands and nighttime headache preventing them from sleeping.

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ITS EFFECTIVENESS IS ALSO A GREAT ADVANTAGE because the homeopathic treatment acts on physical, psychological and behavioral symptoms of a patient offering a more comprehensive and personalized therapy for each patient.

To identify the individualized homeopathic treatment 43 in elderly patients who present with anxiety and insomnia disorders, the physician takes into account the triggering factor (it can be a familial, relationship disorders or following the death of a loved one, etc.), the individual reaction faced with the stressful situation and the expression of the predominant feelings and emotions (fear, rage, sorrow, frustration, anger…), and it is also important in the interview to use a communication centered on the patient 26.

We can use homeopathic medicines 44-46 to help our elderly patients who have anxiety and insomnia issues. And we can do it in a safe and effective manner.

The finality of the attention given to elderly persons must be very different from the one proposed by health representatives, because it is not about identifying the “chronic” 47 patients based on their clinical histories within our Health Center as if we were going fishing, but rather being at their disposal.

Being there for each and every one of them with the primum non nocere 48 as a basic leitmotiv to support the relationship with our patients. Our words and our silences 49 are the keys to understanding and helping each of our patients in an individualized manner. n

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We have misunderstood our mission within Medicine.

We think our mission consists in guaranteeing health and survival. But in reality it is much more than that. It consist in making well-being a reality. And this well-being is really related to the reasons why each person wants to be alive.”

Atul Wagande

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. MOLINA T, CARBALLO M, PALMA D, LÓPEZ S, DOMÍNGUEZ JC, MORALES JC. Prévalence de la polymédication et risque vasculaire chez les plus de 65 ans. Attention Primaire 2012; 44: 2016-2022.

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. Étude nationale sur les effets secondaires liés à l’hospitalisation. ENEAS 2005. Ministère de la Santé et de la Consommation. Madrid, 2006.

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. Étude APEAS. Étude sur la sécurité des patients qui consultent en attention primaire de santé. Madrid.

Ministère de la Santé et de la Consommation; 2008. http://www.msssi.gob.es/organizacion/sns/ planCalidadSNS/docs/estudio_apeas.pdf

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15 . GOTZSCHE P. Médicaments qui tuent et crimes organisés. Sans frontières. 2014.

16 . https://www.nps.org.au/australian-prescriber/ articles/the-seven-year-rule-for-safer-prescribing

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. Ministère de la Santé, des Services Sociaux et de l’Égalité.

Projet MARC. Élaboration d’une Liste de Médicaments à Hauts Risques pour les Patients Chroniques. Communiqué 2014 http://www.seguridaddelpaciente.es/resources/documentos/20 14/Proyecto_MARC_2014.pdf (2014, consulté le 20 octobre 2015).

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. BEERS MH. Explicit Criteria for Determining Potentially Inappropriate Medication Use by the ElderlyAn Update. Arch Intern Med. 1997; 157(14): 1531-1536. doi:10.1001/archinte.1997.00440350031003 https://jamanetwork.com/journals/jamainternalmedicine/articl e-abstract/623574

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. DELGADO SILVEIRA E, MUÑOZ GARCÍA M, MONTERO ERRASQUIN B, SÁNCHEZ CASTELLANO C, GALLAGHER P, CRUZ-JENTOFT A. Prescription inappropriée de médicaments chez les patients âgés : les critères STOPP/START Rev Esp Geriatr Gerontol 2009; 44: 273-9. http://www.elsevier.es/es-revista-revista-espanola-geriatriagerontologia-124-articulo-prescripcion-inapropiada-medicame ntos-los-pacientes-S0211139X09001310

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. HOFMANN B, WELCH HG. New diagnostic tests: more harm than good. BMJ 2017; 358: j3314.

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. DANTAS F, RAMPES H. Do homeopathic medicines provoke adverse effects? A systematic review. British Homeopathic Journal, 2000; 89 (Suppl 1): S35-S38.

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34 . ENDRIZZI C, ROSSI E, CRUDELI L, GARIBALDI D. Harm in homeopathy: aggravations, adverse drug events or medication errors? Homeopathy 2005, 94: 233-240.

23 . MOYNIHAN R, DOUST J, HENRY D. Preventing overdiagnosis: How to stop harming the healthy. BMJ 2012, e3502, 1-6 http://www.bmj.com/content/344/bmj.e3502

35 . FISHER P, DANTAS F, RAMPES H. The safety of homeopathic products. Journal of the Royal Society of Medicine 2002, 95: 474475.

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. CHOCRÓN BENATA L, VILALTA FRANCH J, LAGAZPI RODRÍGUEZ I, AUQUER K, FRANCH L. Prévalence de la psychopathologie dans un Centre d’Attention Primaire.

Attention Primaire 1995; 16, 586-90.

36 . RILEY D, FISHER M, SIGH B, HAIDVOGL M, HEGER M Homeopathy and conventional medicine: An outcomes study comparing effectiveness in a primary care setting. Journal of Alternative and Complementary Medicine. 2001, 7: 149-159.

. Guide de pratique clinique en Attention Primaire sur la gestion des patients qui présentent des troubles anxieux. Ministère de la Santé et de la Consommation.

2008.

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. http://homeopathyeurope.org/Research/ . http://www.hablandodehomeopatia.com/la-homeopatiademuestra-utilidad-estudio-epi-3/

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. https://gualbertodiaz.wordpress.com/2014/06/02/ epi3-laatencion-primaria-francesa-mejora-sus-resultados-al-incorpo rar-la-homeopatia/

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. BORRELL F. Pratique cinique centrée sur le patient.

Editorial Triacastela. 2011.

27 . DÍEZ LLAMBRICH X. notions de psychiatrie homéopathique. www.prescribohomeopatia.com 2013.

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. FRAZZETTO G. Comment nous ressentons les choses.

Editorial Anagrama. 2013.

. https://www.navarra.es/NR/rdonlyres/AB30A9A5-9907-4D68A17A-C4AB0DC524D5/293282/Bit_v22n2.pdf

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42. Canadian Agency for Drugs and Tecnologies in Health.

Discontinuation Strategies for Patients with Long-term Benzodiazepines Use: A review of clinical evidence and guidelines.

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. Guide de pratique clinique en Attention Primaire sur la gestion des patients atteints d’insomnie. Plan de Qualité pour le Système National de Santé du Ministère de Santé et de Politique Sociale. Unité d’Évaluation des Technologies Sanitaires. Agence Laín Entralgo.

Province de Madrid; 2009. Guides de Pratique Clinique au sein du Système National de Santé: UETS N° 2007/5-1.

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. TORRES GARCÍA RM, VICENS CALDENTEY C. Blog de la SEFAP. Stratégies de sevrage des benzodiazépines ou comment ôter la clochette au chat. http://farmaciadeatencionprimaria.com/2014/05/06/estrategias -de-deshabituacion-a-benzodiazepinas-o-como-retirarle-elcascabel-al-gato/ (2014, consulté le 21 octobre 2015).

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https://www.cadth.ca/discontinuation-strategies-patients-longterm-benzodiazepine-use (2015, consulté le 15 octobre 2015).

43 . http://www.hablandodehomeopatia.com/como-tratar -laansiedad-con-homeopatia/

44 . SIMÓ E, TORRES JI, CORDERO J. Pathologies traitées par des médicaments homéopathiques dans un cabinet d’Attention Primaire – Congrès Régional d’Attention Primaire Castille et León. Burgos. 2000.

. TORRES JIMÉNEZ JI. FERNÁNDEZ QUIROGA G, DÍAZ SÁEZ G. Apport de l’homéopathie dans la relation médecin-patient, RevMedHomeopat 2014; 7(1): 39-45.

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. TORRES JIMÉNEZ JI, DÍAZ SÁEZ G, SERRANO MUÑOZ P, GARCÍA GÓMEZ O. Utilisation de médicaments homéopathiques dans un cabinet urbain d’Attention Primaire. Rev Med Homeopat 2017; 10(2): 5358.

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47 . RIERA ARMENGOL L. L’étiquette des patients en Attention Primaire. Le cas de la chronicité. Attention Primaire 2017; 49: 508-9 http://www.elsevier.es/es-revista-atencion-primaria-27articulo-el-etiquetado-pacientes-atencion-primaria--S0212656 717306960

48 . MARSH H. Avant toute chose, ne fais pas de mal. Salamandra 2016.

. http://www.hablandodehomeopatia.com/ homeopatiacuidado-del-paciente-cronico/

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Predict aging to better manage it Possibilities of homeopathy in the treatment of Major Neurocognitive Disorders

Guy Villano, MD - France

1

Definitions of Neurocognitive Disorders The term “neurocognitive disorders” has replaced the term “senile dementia”.

WE CAN DIFFERENTIATE: > Minor Neurocognitive Disorders = mNCD. > Major Neurocognitive Disorders = MNCD.

I / MINOR NEUROCOGNITIVE DISORDERS correspond to age-related mild cognitive deficits, the old MCI (Mild Cognitive Impairment) characterized by cognitive impairments without an impact on activities of daily living.

However, minor NCD can very frequently precede by several years major NCD. Opening the possibility of prevention that we will detail in this article.

II / MAJOR NEUROCOGNITIVE DISORDERS ENCOMPASS

A / DEGENERATIVE MNCD • Formerly Alzheimer-type dementia It is Alzheimer’s disease, which is an amyloid pathology.

> MRI and CT-Scan imaging unveil an atrophy of the brain and hippocampus along with some vascular lesions that can be more or less important.

According to the persons, the evolution of Alzheimer’s disease can span over a 5 to 20-year period.

There are several clinical pictures of Alzheimer’s Disease, they all share the same cognitive disorders.

1. THE PHASIC FORM It is characterized by: • Difficulty in finding the right words, • Circumlocution, paraphrases, • Slowed down verbal flow, • Aphasia with progressive loss of speech.

2. DISINHIBITED FORM In the disinhibited form, we observe: • Changes in behavior, • Irritability even aggressiveness, • Stubborn subject who will only do as he pleases, • Subject who curses, utters obscenities, • Subject who walks and moves relentlessly, • Subject who talks about his life to anyone he meets.

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• Degenerative MNCD, • Lewy Body Dementia MNCD, • Vascular MNCD, • Frontal MNCD.

It is characterized by disorders of the immediate memory and working memory followed by long-term memory disorders.

It is also associated with multiple and variable behavioral disorders.

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3 / THE DEPRESSIVE FORM It is unveiled by the rapid onset of withdrawal, depressive state, for no reasons in an elderly person.

4 / THE APATHIC FORM It consists of: • Loss of motivation, • Incapacity to feel emotions, • Impairments in performing certain daily life tasks, • Loss of recognition for objects and persons, • Loss of any spontaneous activity, • Total dependence.

> Of course, the symptoms of these different clinical forms can be found in one same patient.

These 23 MNCD concerned 13 men and 10 women ranging in age from 61 to 78 at the time of diagnosis, among them we find: • 16 degenerative MNDC (Alzheimer’s disease), • 3 MNCD Lewy’s body disease, • 3 vascular MNCD, • 1 frontal MNCD. We will focus on the symptoms of Alzheimer’s disease (AD) common to all other major neurocognitive disorders.

AD symptoms evolve, their onset is slow and the aggravation is progressive.

GENERALLY THE FOLLOWING SYMPTOMS APPEAR SUCCESSIVELY

B / MNCD: BODY LEWY’S DISEASE Anatomically there is a pathology of the basal ganglia.

We find the same clinical picture than in Alzheimer’s disease: • In addition we observe a Parkinson’s syndrome, recurrent falls, visual hallucinations, intolerance to neuroleptics and disorders during paradoxical sleep, • As well as a depressive state in a patient who was very realistic about his own state for a long time.

• Difficulties finding the right word, • Difficulties concentrating, • Impairments to immediate and working memory, • Slowed down verbal fluency, • Mood disorders, • Distorted reasoning and judgement, • No longer recognizing things or people, • Social isolation, • Spatiotemporal disorientation, • Absence of any spontaneous activity.

C / VASCULAR MNCD

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Arteriosclerosis and ischemic stroke are the cause of this MNCD. Here also, we find the same clinical pictures than in Alzheimer’s disease associated with potential neurological disorders.

D / FRONTAL MNCD

HERE ARE SOME OF THE MOST USEFUL. THEY ARE

We find an atrophy of the frontal regions.

Frontal MNCD affect younger subjects who present the same clinical symptoms than in Alzheimer’s disease with major behavioral and mood disorders.

ESSENTIAL IN MY PRESCRIPTION.

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> Symptomatic homeopathic medicines can act, on the progressive nature of the characteristic symptoms of Alzheimer’s disease.

Accompanying Major Neurocognitive Disorders This work is based on the study of 23 patients with major neurocognitive disorders with a multidisciplinary follow-up from 6 to 11 years.

(Of course this list is not exhaustive).

EARLY STAGE OF ALZHEIMER’S DISEASE

FOUR medicines frequently prescribed in the early stages of AD: Natrum muriaticum, Nux moschata, Medorrhinum, Anacardium orientale.

NATRUM MURIATICUM KEY SYMPTOMS • Difficulty concentrating,

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• At loss for words.

TELLTALE SYMPTOMS • Absolutely no immediate memory: memory loss for recent events, for what he wants to do or what he is doing, • Poor recollection or even absence of recollection after the fact.

SYMPTOMS OF AGGRAVATION • Makes mistakes when talking, • Says things he did not intend to say, • Loss of interest for daily life, • Withdrawal, • Mistaking places, • Presents with spatiotemporal disorientation.

TO BE NOTED • Natrum muriaticum is the medicine for “body hydration and thus brain hydration”.

NUX MOSCHATA KEY SYMPTOM • Forgetting things when doing them.

TELLTALE SYMPTOMS • Complains that “ideas are escaping him” while talking, reading, • Severe impairment of the short-term memory and the working memory.

SYMPTOMS OF AGGRAVATION • Does not recognize familiar streets, friends, • Goes to sleep suddenly, • Hallucinatory body representation disorders: two bodies, two heads…, • Spatiotemporal disorders: confuses the present with the past, • Indifference, • Listlessnes.

ANACARDIUM ORIENTALE KEY SYMPTOM • Remembers some facts but not others.

TELLTALE SYMPTOMS • Selective memory unveiling a dual personality related to a deep anxiety, • Annihilating irresolution and indecision first episodic, then constant and pathological.

SYMPTOMS OF AGGRAVATION • Total loss of working memory, • Implicit long-term memory impairment: cannot remember how to do things, • Aggressive irritability alternating with depression, • Auditory, olfactory and visual hallucinations: sensations of hearing voices behind his back, sensation of smelling unreal odors, sensation of being separated from the world, sensation that the face in the mirror is not his own. n DOSAGE IN THESE “EARLY STAGES” OF ALZHEIMER’S DISEASE Prescribe 1 or 2 medicines according to the symptoms found: • 9-15 CH: 5 pellets once to twice a day continuously, • Reassessing the treatment every 3 months, • Privileged associations Natrum muriaticum - Nux moschata.

“ADVANCED STAGES” OF ALZHEIMER’S DISEASE

SIX medicines are most commonly prescribed in the “late stages” of AD: Alumina, Petroleum, Baryta carbonica, Kalium bromatum, Mercurius solubilis, Plumbum metallicum.

MEDORRHINUM ALUMINA KEY SYMPTOM • He is confused.

TELLTALE SYMPTOMS • Makes mistakes when writing or talking, • Incapable of talking a decision, • Uncertain, abulia, • Confused awareness of his identity, name.

AGGRAVATION SYMPTOMS • Judgement disorders that can lead to a false perception of reality, • Believing that someone else said what he himself said,

JANUARY 2018 CEDH MAGAZINE

KEY SYMPTOMS • Instability, • Agitation.

TELLTALE SYMPTOMS • No apprehension of the fact, • Amnesia for short-term events, • Forgets what he just heard, • Does not have the memory for proper nouns.

SYMPTOMS OF AGGRAVATION • Cannot follow the thread of a conversation, • Loses his train of thoughts, • Forgets the notion of time, mistakes the present and the past.

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BARCELONA 2017

• We are looking at a prematurely aged, thin, prostrate and dried-up patient. Conscious of his deficits, he believes time passes too slowly, with depression and suicidal thoughts.

TO BE NOTED • We know that aluminum is found in the brain of certain patients affected by Alzheimer’s Disease Alumina certainly has a halting and preventive impact on the development of all major neurocognitive disorders.

• Progressive loss of language.

SYMPTOMS OF AGGRAVATION • Thin, agitated, weakened, anemic and nervous elderly person, • Hollow, vacant look, • “Aggressive” and sporadic sexual arousal, • Moral and intellectual depression, • Withdrawn from the world, • Completely indifferent to his business, his closed ones, the outside world.

PETROLEUM KEY SYMPTOM • Gets lost in the streets.

TELLTALE SYMPTOMS • Total absence of short-term memory and affected long-term memory, • Has no idea where he is, • Doesn’t know who he is.

SYMPTOMS OF AGGRAVATION • Visual and auditory hallucinations, • Illusions: he is not alone in his bed, • Duplication of a limb, part of his body, • Severe anxiety of imminent death, • Puts his affairs in order, • Confused, irritable, irascible, irresolute elderly person, getting lost in the streets. Third party needs to sew his name and address on his clothes.

BARYTA CARBONICA

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KEY SYMPTOM • He keeps repeating things.

TELLTALE SYMPTOMS • Total anterograde amnesia and partial retrograde amnesia, • Very slow to understand, • Does not remember anything, events or places, • No recollection of space and time landmarks.

SYMPTOMS OF AGGRAVATION • Often shy and despondent, he can, when disinhibited by the disease, become aggressive, stubborn, rude, and obscene. He can talk non-stop “like a broken record” about his childhood to everyone he meets.

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KALIUM BROMATUM KEY SYMPTOMS • Depression, • Sexual arousal.

TELLTALE SYMPTOMS • Loss of working memory, • Loss of long-term memory, • Forgets words, syllables,

MERCURIUS SOLUBILIS KEY SYMPTOM • Quiet stupor.

TELLTALE SYMPTOMS • Comprehension difficulties, • Slow to respond and giving wrong answers.

SYMPTOMS OF AGGRAVATION • Severe decline in intellectual capacities, • “Bovine” look, • Social isolation, • Complete and quiet state of “imbecility”.

PLUMBUM METALLICUM KEY SYMPTOM • Brain is “shutdown”.

TELLTALE SYMPTOMS • No anterograde or retrograde memory, • Unable to express himself, • Doesn’t understand a thing.

SYMPTOMS OF AGGRAVATION • Very quickly we will be faced with an emaciated, gaunt, slowed-down and shaking elderly with a yellowish complexion, • Melancholic, quiet and distant, withdrawn, • Disconnected from reality.

TO BE NOTED Plumbum metallicum is one of the main medicines for generalized arteriosclerosis, brain sclerosis and the eclipses it causes.

It is often a very severe clinical picture of Major Neurocognitive Disorders. n DOSAGE FOR AD IN THE “LATE STAGES” Prescribing 1 or 2 medicines according to the symptoms observed: • 9-15 CH: 5 pellets once or twice a day continuously, • Reassessment of the treatment every 3 months.

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Possibilities of homeopathy in the treatment of Major Neurocognitive Disorders

6TH INTERNATIONAL CEDH CONFERENCE BARCELONA 2017

FOR “EARLY STAGES” AND “LATE STAGES” OF AD

WHAT IS THE EFFECTIVENESS OF THESE TREATMENTS?

One essential medicine is systematically prescribed

LUESINUM KEY SYMPTOM • Deconstruction.

TELLTALE SYMPTOMS • No apprehension of the fact, > No memory storage of the fact, > No recollection of the fact.

SYMPTOMS OF AGGRAVATION • Deconstruction of the memory process, • Loss of brain adaptability due to early-onset sclerosis, • Loss of spatiotemporal landmarks, • Complete amnesia of present and past events, • Cannot remember the name of his children, • Gets lost in his neighborhood, own house, • Diverse obsessions (cleanliness), • Nighttime hallucinations and agitation. n DOSAGE OF LUESINUM • To give as a curative treatment, but mostly in prevention, as a sentinel medicine, • Systematically in 15 CH, 1 or 2 doses every week continuously, • Reassessing the treatment every 3 months.

The multidisciplinary evaluation, which included healthcare professionals (physician in charge, geriatrician, neurologist, homeopath, nurses, professional caregivers) but also family and family caregivers of these 23 patients observed a therapeutic benefit: • Better quality of life of the patients and by extension improved quality of life for their closed ones, • For 18 of them improvement of cognitive abilities, • Relative stable progression of the disease over time, • Slowed-down appearance of aggravating symptoms.

3

Regarding this medicine, it is interesting for homeopathic physicians to note that “recent observations unveiled the presence of various periodontal spirochetes and Borrelia burgdorferi in the brains of patients with Alzheimer’s disease, indicating that these diverse spirochete types, similarly to Treponema pallidum (Syphilis), could persist in the brain and trigger Amyloid-beta (A) plaques and Alzheimer’s disease” (Judith Miklossy, MD).

But I suggest we go further!

Anticipating and preventing Major Neurocognitive Disorders 23 patients studied, 23 major neurocognitive disorders.

Among them: 6 Arsenicum album, 4 Aurum metallicum, 3 Calcarea carbonica, 7 Lycopodium, 3 Sepia officinalis.

Is it random luck? No! So… Is there a possibility of anticipation?

A possibility of prevention of these MNCD?

> MNCD RISK FACTORS ARE GENETIC AND EPIGENETIC

GENETIC FACTORS In Alzheimer’s disease the most important genetic factor is linked to the Apolipoprotein E gene (ApoE4 allele) on chromosome 19. Other genes are involved.

However, their sole presence is not sufficient to trigger the pathology.

JANUARY 2018 CEDH MAGAZINE

IMPORTANT These “symptomatic” medicines are prescribed as “curative treatment” to manage existing symptoms. But also in “preventive anticipation” to slow-down the onset of predictable symptoms to come

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Predict aging to better manage it

BARCELONA 2017

EPIGENETIC FACTORS • Age is the main risk factor in Alzheimer’s disease, • Traumatic life events…social isolation can speed up or even induce this physical and intellectual aging, • High-blood pressure, diabetes, dyslipidemia, obesity speed up the cognitive decline.

TELL ME WHO YOU ARE AND I WILL TELL YOU • How you might age, • What impact traumatic life events will have on you, • if you are likely to develop high-blood pressure, type 2 diabetes, dyslipidemia, obesity…

• All through life Arsenicum album has had issues with storing and retaining information.

• His constant anxiety of wanting to control everything leads, among other things, to continuously questioning the reliability of his memory.

• At first he notes everything down to reassure himself that he hasn’t forgotten anything but very quickly, in a second stage, he will note everything down to not forget things.

Telltale sign of minor NCD, this memory storing disorders, will progressively lead to memory restitution disorders that will ineluctably get worse.

TELL ME WHO YOU ARE = MEDICINE OF THE PERSON Homeopathy can influence these epigenetic factors and thus can allow us to anticipate, prevent or delay the development of Alzheimer’s disease.

YES surely!

How? Thanks to the Medicine of the Person prescribed in prevention after having identified the precursor signs of the eventual onset of the disease.

Not everyone has at anytime any type of pathology for any reason.

We develop pathologies that look like us.

Out of the 23 patients studied suffering from major neurocognitive disorders we had 6 Arsenicum album and 7 Lycopodium.

JANUARY 2018 CEDH MAGAZINE

(At the Barcelona conference, I only covered these two medicines. It is obvious that not all Arsenicum album or Lycopodium will automatically develop MNC and even more so because we will be vigilant and anticipate it).

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ARSENICUM ALBUM KEY SYMPTOM • The king of the post-it notes!

TELLTALE SYMPTOMS • Arsenic will note down every things so he doesn’t forget them!

SYMPTOMS OF AGGRAVATION • Concentration difficulties, • Working memory disorders, • At loss for words, • Slowed-down verbal fluency, • Mood disorders (paroxysmal anger fits and anxious state).

As time goes by, clear-headed about his downfall, Arsenicum album exhausts himself fighting it. His fear of physical and psychological aging, his death anxiety lead to an obsessive need to control his own life.

This highly-organized person sees that all his “protective” strategies are becoming powerless to fight the attacks of aging.

Weakened, having lost his life landmarks, sclerotic in his brain and arteries ++, he will let go and inexorably withdraw from the world and collapse.

He is a shriveled, emaciated, weak, coldsensitive, anxious, depressive person but still sometimes quite meticulous and stingy. He has become locked-up in his Alzheimer’s disease.

“

We develop pathologies that look like us.”

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“

Can homeopathy influence these epigenetic factors and thus can allow us to anticipate, prevent or delay the development of Alzheimer’s disease? YES surely!”

LYCOPODIUM

KEY SYMPTOM • The great forgetful.

TELLTALE SYMPTOM • Weak and imprecise recollection, > doesn’t remember what he just did or what he read.

SYMPTOMS OF AGGRAVATION • Forgets words while talking, • Uses incorrect words, • Gets mixed up in syllables when spelling, • Forgets proper nouns, • Makes mistake when writing things down, • Confuses or forgets letters, • Looks for the right word, cannot find it so, • Forgets his appointments.

Engaged in a perpetual intellectual challenge with “others” for his own survival, aware of his limits and eaten up by his lack of self-confidence, he fears his intellectual downfall.

• Poor hepatic and renal function, glucose and lipid metabolic disorders promoting general and progressive arteriosclerosis fostered by a very limited physical activity…

• Emotional or work-related “psycho-intellectual” traumatic events in this proud being…

All of this will lead to the premature aging of Lycopodium. His brain gives away at the same time as his body

THESE DISORDERS BRING UP MINOR NCD

Succeeding to an often brilliant and dominating person, he becomes a teary and irascible “young elderly”, derelict both on physical and psychological levels, he will finish his life haggard and disoriented

Paradoxically they appear early on in a person poorly fed in energy by a deficient liver

THE TRAGEDY OF WRITTEN.

ALZHEIMER’S DISEASE IS ALREADY

JANUARY 2018 CEDH MAGAZINE

IS THIS DISORDER COMING FROM HIS TOO IMPORTANT INTELLECTUAL WORRIES?

and has as his sole asset a brain that he solicits so much that he seems more intelligent than others.

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BARCELONA 2017

n THE DOSAGE FOR THE MEDICINE OF THE PERSON • IN ANTICIPATION OF THE MAJOR NCD - 15 CH: 1 dose per month (at least) right from the beginning of the symptoms of the minor NCD over a period of several years.

JANUARY 2018 CEDH MAGAZINE

• IN DIAGNOSED MAJOR NCD - 9-15 CH: 5 pellets every day up to 1 dose per week prescribed as the Medicine of the Person at the same time of the indicated symptomatic medicines. n

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“

Anticipating Preventing Delaying the Major Neurocognitive disorders.

The challenge is an important one.

Homeopathy can face up to it.

Our patients will benefit from it.”

31-36Endometriose.qxp_essai JAN 09 24/05/2018 10:44 Page31

EVERY6TH INTERNATIONAL CEDH CONFERENCE DAY BARCELONA 2017

Endometriosis a model of care management in integrative medicine

Christelle Besnard-Charvet, MD - France

E

ndometriosis affects 10% of women. The diagnosis is often a late one, eight to twelve years after the first symptoms. Conventional medical-surgical management usually helps to stabilize the pathology, but similarly to cancer pathologies; it is most often only a remission and not a complete healing.

Our global and individualized vision of healthcare leads us to ask several questions: who are the women who present with endometriosis? Do they have a specific profile?

Why do they “trigger” this pathology? Why do they all present with different types of endometriosis?

GENERALITIES > There is not ONE endometriosis but patients with varying symptoms of endometriosis. > The therapeutic consequence is to approach the care management of endometriosis like the one for any multifactor chronic disease with a philosophy of integrative medicine associated with conventional medicine and complementary approaches.

Endometriosis is defined by the presence and the abnormal development of hormone-dependent endometrial tissue outside of the uterine cavity.

Even though the pathology has been known for over 150 years (first description in 1860), there are still several theories to explain the localizations of endometriosis:

• The reflux theory, first theory described in 1927: the reflux of the periods by the fallopian tubes would retain some endometrial tissue that will secondary attach to the pelvis and the abdomen, but how can we explain the rare cases of male endometriosis and endometriosis in women with no uterus?

• The metaplasia theory: peritoneal cells change into endometrial cells under the effect of exogenous agents, but how can we explain their migration to the brain?

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1

Endometriosis definition

2

Pathophysiology of endometriosis

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Endometriosis: a model of care management in integrative medicine

BARCELONA 2017

• The induction theory must be taken into account: the endometrium releases immature cells that change into functional endometrial cells.

• The theory of vascular and lymphatic emboli: endometrial tissue is carried by the vascular or lymphatic pathway.

The endometrial tissue is inflammatory. It presents specificities by expressing tenfold a key enzyme for prostaglandin synthesis: PTGS2. It also expresses 10 to 20 times more the three coding genes (out of four) for prostaglandin receptors.

3

Lesions of endometriosis Lesions can vary; typical lesions are red or bluish and very small (in the order of mm²); they can be recent lesions, with a bluish nodular aspect or older fibrotic, retractile and white lesions.

The endometrial cells can develop in the uterine muscle: this is adenomyosis; we will not cover this here because it is a specific type of endometriosis.

They can affect extra-uterine pelvic organs (vagina, ovaries, fallopian tubes, peritoneum, bladder, bowels), but also organs at a distance (lungs, brain, umbilicus, episiotomy scar).

We differentiate also the superficial peritoneal endometriosis from the deep sub-peritoneal endometriosis, or ovarian endometriosis (endometriomas, or endometriotic cysts).

Ovary Uterus Bladder JANUARY 2018 CEDH MAGAZINE

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Epidemiology The prevalence of endometriosis has gone from 2 to 10% in the 1980-1990 to 10-15% today (mostly because there is a better screening for it).

However, endometriosis affects 20 to 50% of infertile women.

There are multiple risk factors for endometriosis: menstrual cycle disorders with short cycles and heavy periods, early-onset puberty, low Body Mass Index, family history, autoimmune terrain. There is also a specific terrain of associated complications with hyperesthesia and chronic pain.

A psychological terrain was also reported, with a predominance of anxious or depressed tendencies. Environmental factors were incriminated: endocrine disruptors, bisphenol A (BPA), dioxin…

Intense exercising (more than 7 hours per week) and oral contraception are protective factors.

5

Clinical picture

Oviduct

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THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE (ASRM) SCORE is established after endoscopic exploration and allows the classification of endometriosis into four stages, but there is no correlation between the stages and the symptoms.

Vagina Rectum Lips

The most common symptom is dysmenorrhea: periods that are particularly painful, sometimes since the onset of puberty (primary dysmenorrhea), but sometimes the pain came later.

Cervix

Endometriosis Most frequent localizations of pelvic endometriosis.

Pain is severe and is poorly relieved or not relieved by analgesics. It can be associated with other type of abdominal-pelvic pain, cyclic or not, and especially severe dyspareunia.

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Menorrhagia is a common associated symptom.

A group of multiple symptoms was described in thin young women, full of energy with associated digestive pain, transit disorders, vulvar pruritus anxious disorders and panic attacks; a specific terrain that speaks to us as homeopaths.

6

Complementary examinations Pelvic ultrasound helps diagnose endometriosis in the ovarian, recto-uterine pouch, recto-vaginal lining.

MRI remains the imaging exam of reference to diagnose retractile fibrotic lesions, not detectible with the ultrasound. This MRI exam must be interpreted by radiologists who are very experienced about endometriosis images.

7

Care management in integrative medicine The latest best practices recommendations for endometriosis management date back to 2005 (AFSSAPS and CNGOF); they should have been updated in 2016 by the French Health Authority.

Conventional management includes medical and surgical indications; it is important to note that symptomatic patients should be treated.

Other medical treatments are designed to inhibit the ovarian function to avoid the

Surgical treatments, which were the Gold Standard in the eighties and nineties, are no longer recommended: as a matter of fact the technique that consisted in the surgical removal of all endometriosis nodules might have created adhesions and aggravated some of the symptoms. Laparoscopic surgery is preferentially indicated for major pain. Surgery is useful when the endometriosis is located in specific areas (bowels, bladder) and must be performed by a surgeon experienced in this type of pathology. This type of surgery is difficulty, hemorrhagic and it could have dramatic consequences for the patient.

COMPLEMENTARY APPROACHES are relevant because of their specific focus on the patient presenting with endometriosis and the causes of this pathology.

• Psychological support is essential: chronic pain leads to psychological disorders and we saw that some anxious personalities were more inclined to develop endometriosis.

• Nutrition will also have a privileged place by limiting endocrine disruptors to avoid stimulating the endometrial tissue, by discarding pro-inflammatory products (industrial ones mainly) and privileging anti-inflammatory foods (fruits, vegetables and spices).

• Physical activity will also have an impact on factors promoting inflammation and improving the hormonal cycle.

• Acupuncture can relieve some menstruation-related pain.

• Meditation, relaxation, yoga and other types of techniques will decrease the stress, anxiety and the perception of pain.

JANUARY 2018 CEDH MAGAZINE

The main medical treatments are antiinflammatory drugs prescribed for menstruation pain. For dysmenorrhea the following medicines are approved in France: mefenamic acid, triaprofenic acid, diclofenac, flurbiprofen, ibuprofen, ketoprofen, and naproxen. However, the risk of side effects, specifically digestive ones, limits their use.

hormonal stimulation of endometrial tissues: estrogenprogestin oral contraceptives perfectly suited when there is a need for contraception, macroprogestins useful when there is a contraindication to estrogenprogestin contraceptives, and LHRH analogs appropriate before an IVF. Dienogest (specific progestin) has shown its effectiveness, in France it is marketed under the name Visanne® (one 2mg tablet per day) but it is not reimbursed and it does not act as a contraceptive method. Hormone IUDs are very effective for painful periods, heavy periods and when there is a need for contraception.

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6TH INTERNATIONAL CEDH CONFERENCE

Endometriosis: a model of care management in integrative medicine

BARCELONA 2017

8

The place of homeopathy in endometriosis management Similarly to adjunctive care in oncology, the homeopathic care management acts at all stages: • at the time of the diagnosis, • at the time of the surgery: preoperative and postoperative.

We will not detail this management, because it is not different than the one used in surgery or oncology.

We will insist here on the place of homeopathy for endometriosis.

PAIN MANAGEMENT The objective is not to discard analgesics, but to complete their action, and limit an excessive consumption.

SABINA heavy periods. Violent low back pain and sacral pain, from the sacrum to the pubis, radiating to the thighs,

TRILLIUM PENDULUM crushing-like pain, improved by wearing tight clothes.

CARE MANAGEMENT OF RELATIVE HYPERESTROGENIA FOLLICULINUM is particularly adapted in high dilutions, since patients often present with menorrhagia and short cycles, even without a premenstrual syndrome. n One dose in 15 CH to be taken on Day 8 and Day 20 of the menstrual cycle.

THE FIRST MEDICINE TO LOOK AT IS ACTAEA RACEMOSA It is a medicine of endocrine system dysfunction, with hyperestrogenia; the type of period-related pain reacting to Actaea racemosa is pain that roportional to the flow, cramping pain improved by heat. n Actaea racemosa 9 CH 5 pellets 2 to 4 times a day as soon as the pain starts. n We can also think of other medicines for painful periods prescribed in 5 to 9 CH, 5 pellets several times a day right from the beginning of the pain:

COLOCYNTHIS

JANUARY 2018 CEDH MAGAZINE

cramping pain, improved by strong pressure and when bent in two,

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A study reported the efficacy of estrogen dilutions on pain, when prescribed twice a day during 6 months. It reported a significant improvement of the Endometriosis-Associated Pelvic Pain (EAPP) score vs. placebo, along with an improvement of the depressive symptoms.

LUTEINUM is also an interesting strain, the extract of the yellow body contains estrogens and progestin, which can be interesting in case of luteal phase deficiency with a desire to get pregnant (poor quality ovulation, short cycle). n IT WILL BE PRESCRIBED IN 5 CH, for example one dose on Day 21 of the cycle or 5 pellets per day from Day 21 of the cycle until the onset of menses.

MAGNESIA PHOSPHORICA paroxysmal pain before the periods and improved by applying strong pressure, when bent in two and friction,

CAULOPHYLLUM Light periods, "false" labor pains (Braxton Hicks contractions),

TERRAIN MEDICINES There is not just one kind of endometriosis, nor one type of patient who develops endometriosis; it is essential to look at the terrain.

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Potentized estrogen in homeopathic treatment of endometriosis associated pelvic pain.

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40

35

35

30

30

Depression symptoms (BDI) score

EAPP global score

Teixera MZ, Podgaec S, Baracat EC. Eur J obstet gynecol Reprod Biol 2017, jan 25 ; 211: 48-55.

25 20 15 10 5

25 20 15 10 5

0

0 0

8

16

24

0

Weeks of treatment

8

16

24

Weeks of treatment Placebo

Potentized Estrogen

Change in the score (mean difference — MD) of depression symptoms (BDI) from baseline to week 24 in groups potentized estrogen and placebo (per-protocol analysis).

SENSITIVE TYPES In our experience several sensitive types can be prone to endometriosis. n THE PRESCRIPTION IS IN 15 CH 5 pellets per day to one dose per week according to the symptoms (pellets in the acute phase of the pathology, dose/week during the remission phase to avoid recurrent episodes).

NUX VOMICA hyperesthesia, prone to spasms, intolerance to pain,

IGNATIA AMARA mood swings, spasmodic terrain,

STAPHYSAGRIA think about this medicine if there is an unresolved or secret conflict/issue. Irregular, late-onset, heavy periods. Person prone to depression in the morning, excessively touchy, frustration.

WE WILL ALSO THINK ABOUT SPECIFIC MEDICINES FOR PAIN-

WE WILL LIST

RELATED BEHAVIORS

VERATRUM ALBUM ACTAEA RACEMOSA painful periods, context of hyperestrogenia, psychological symptoms,

tendency to vasovagal syncope, vomiting, diarrhea during the periods, panic attacks,

CHAMOMILLA VULGARIS SEPIA OFFICINALIS

(agressivity towards pain, anger, agitation, irritability).

pelvic heaviness, depression, mainly context of hypoestrogenia,

CHRONIC REACTIONAL MODE (CRM) PULSATILLA

PLATINA alternation of psychological and physical disorders, high self-esteem, menorrhagia and dysmenorrhea,

It can vary. The prescription is in 15 CH, one dose per week, to stabilize the treatment of the acute episodes and limit the recurrences.

The clinical pictures often bring up a Sycotic CRM: it is the case of endometrial tumors (endometrioma, large nodule of the recto-vaginal lining) with an insidious progression.

JANUARY 2018 CEDH MAGAZINE

painful periods, self-deprecation and lack of self-confidence,

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Endometriosis: a model of care management in integrative medicine

BARCELONA 2017

The choice between the following medicines will be based on localizations, sensations, modalities and concomitant signs:

NITRICUM ACIDUM menorrhagia and metrorrhagia with bright red blood; sensation of heaviness; splinter-like anal pain during bowel movements; spasmodic contractions of the anus; chronic and deep affections with inflammation and prone to hemorrhages. Interesting in the rare localizations of endometriosis (perineum, cervix, vagina),

THUYA OCCIDENTALIS Pelvic pain during the periods and in between the periods; dyspareunia, painful bowel movement; tissue infiltration and endometriosis especially on the left side,

CAUSTICUM periods only during the day, paroxysmal, tearing pain especially on the right side, as if the painful area was a raw wound, adhesions, and fibrosis.

• She had surgery for endometrioma on her right ovary in September 2013, • She had two children without difficulties and would like a third one, • She was treated for 3 months by LHRH analogs, • Painful periods, • She does not wish to use medically assisted procreation, • She would like some explanations on endometriosis, its risks and asks how to decrease the risk of recurrence, • Rather heavy periods, • Her cycles are regular since she stopped the LHRH analogs, • Dysmenorrhea managed with NSAIDs, • Body Mass Index at 26.

At the end of the consultation I give her some diet advice (avoiding pro-inflammatory foods such as industrial products, dairies), and recommend she exercises regularly.

THE REACTIONAL MODE CAN BE LUETIC, often in older endometriosis lesions with scars: ulcerations, history of smoking.

HOMEOPATHIC TREATMENT: n Thuya occidentalis 15 CH one dose per week, n Folliculinum 15 CH one dose on day 8 and day 20 of the cycle, n Luteinum 5 CH one dose on day 21 of the cycle, n Actaea racemosa 9 CH, 5 pellets, 3 times a day during the periods.

CALCAREA FLUORICA Shooting, throbbing pain radiating to the thighs, improved by massage and hot applications. Anxiety, constant indecisiveness.

THE TUBERCULINIC REACTIONAL MODE IS COMMON: subjects who are easily tired, prone to ENT disorders, mood swings, nervous hypersensitivity and weight loss.

NATRUM MURIATICUM pelvic heaviness, heavy, irregular periods, migraines, severe constipation, acne before the onset of menses,

PULSATILLA pelvic heaviness, light periods, mood swings, lack of self-confidence, and variable transit,

JANUARY 2018 CEDH MAGAZINE

SILICEA

36

heavy periods, with sensation of icy cold, constipation before and after the periods, rectal pain, mental exhaustion, discouragement, lack of physical reaction, progressive weight loss.

PRESCRIPTION EXAMPLE

MRS. C, 37, CONSULTS FOR MANAGEMENT OF HER ENDOMETRIOSIS

9

Conclusion Endometriosis is a multifactor pathology with a growing incidence leading to physical and psychological pain.

Women with endometriosis must benefit from integrative medicine in association with the most adapted medical and surgical treatments, a psychological approach and complementary therapies to improve the quality of life and stabilize the pathology.

Homeopathy is there for the patient all during her care pathway, preparing her for surgery, co-treatment for the pain and especially by taking into account her specific terrain. n

37-44Addictions.qxp_essai JAN 09 24/05/2018 10:46 Page37

EVERY6TH INTERNATIONAL CEDH CONFERENCE DAY

Addictions a major public health concern

BARCELONA 2017

Patrick Vachette, MD - France

ddictions are a major public health concern because they have severe

A

consequences on both Health and Social levels. Their management must be a dual one: the care management of the dependent patient and the reassessment of the family and society responsibilities. There are two types of addictive behaviors:

• Addiction to psychoactive substances: alcohol, tobacco, prescription drugs, food, drugs • Addiction without drugs: work, internet, video games, exercise, shopping, piercings, tattoos… Before treating addictions with or without pharmacological agents, it is interesting to understand the underlying mechanisms and think about their symbolic meaning.

We will look at the profiles of at-risk patients, then at targeted homeopathic medicines suited to each type of addiction

GENERALITIES

1

Mechanisms of action in addictions

In the reward network, there are some neuroanatomical connections with three other networks: • Memory and learning, • Stress regulation, • Motor functions.

2

Definition The etymology of the term “addiction” comes from the latin ad-dicere, i.e. “to declare”. In Roman law, this word was associated to the formal delivery of a person as ruled by a judge.

If a person was incapable of reimbursing his debt to a third party, he was handed out to said third party as a slave.

Today the term of addictions encompasses more largely toxic addictions with or without drugs. A patient can have multiple addictions or switch from one addiction to the next.

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Behavioral addictions are marked by a dysfunction of the Central Nervous System at the level of the reward system network.

Brain stimulations release neuro-hormones such as dopamine, which is the pleasure hormone.

This explains the power of the addictive state that uses memory and conditioning, along with compulsive motor behaviors.

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THE DEFINITION ACCORDING TO AVIEL GOODMAN

“

Addiction is a behavior based on a repetitive and irrepressible need in spite of the motivation and efforts of the person to overcome that need.”

The definition given by this American psychiatrist, in 1990, seems to be consensual and accepted by the different theoretical, psychological, psychiatric and sociological currents.

The vision of these different currents focuses either on the behavior of the subject and the object of his addictions, or on the subject himself and his difficulties in his environment.

CRITERIA • IMPOSSIBILITY to resist the impulsions to act on the need, • Growing sensation of TENSION immediately preceding the beginning of the episode, • PLEASURE or RELIEF during the episode, • Sensation of LOSS OF CONTROL during the episode, • Presence of at least FIVE of the nine following criteria: 1. Frequent PREOCCUPATION regarding the behavior or its preparation.

8. Strong TOLERANCE, leading to increasing the intensity or frequency to obtain the desired effect or decreasing the effect triggered by a behavior of the same intensity.

9. AGITATION or irritability when it is impossible to give in to the behavior.

Some elements of the syndrome can last MORE THAN ONE MONTH or be repeated over a longer time period.

3

Factors promoting the development of at-risk behaviors INDIVIDUAL FACTORS: • HISTORY OF SOMATIC OR PSYCHOLOGICAL SUFFERING

IN EARLY CHILDHOOD

- Sleep disorders, - Affective deficits, - Break-ups.

• THOSE WHO HAD NOTHING OR THOSE WHO HAD EVERYTHING

2. INTENSITY and DURATION of the episodes that gradually become more important than the person wanted originally.

3. Repeated attempts to control, decrease or give up the behavior.

• DURING ADOLESCENCE: - nervousness, malaises, depressive symptoms, - behavioral disorders: fights, theft, running away.

FAMILY FACTORS 4. Important time dedicated to PREPARING the episodes, PUTTING THEM INTO ACTION or GETTING OVER THEM.

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5. Frequent onset of episodes when the subject must perform work-related, educational, familial or social OBLIGATIONS.

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6. Major social, professional or leisure activities are SACRIFICED because of the behavior.

7. CONTINUING the behavior, even though the subject know he is causing or aggravating a lingering or recurrent problem whether it be social, financial psychological or physical.

• conflict or family dissociation, • poor parental behavior: alcohol, psychotropics, • moving to another city, another country with loss of familiar landmarks, • relationship disorders between the adolescent and his parents, • denial of parents who do not want to confront the problem, • major anxiety with overinvestment of the parents, • history of unresolved grief or place in the family.

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ENVIRONMENTAL FACTORS • poverty, unemployment, • exclusion, alienation of the adolescents (school or neighborhood), • idleness, rupture.

5

Considerations on addictions to video games, gambling VIDEO GAMES

COMORBIDITIES • Anxious disorders, • Sleep disorders, • Depression, • Sensitive Type (ST), • Eating disorders, • Impulsive and antisocial disorders, • School difficulties, rupture with the school system, • At-risk behaviors and multiple accidents, • At-risk sexual behavior (multiple partners, unprotected sex), • Relationship difficulties: isolation or seeking marginal relationships.

4

Factors promoting the sustainability of at-risk behaviors The addictive pathology is even worse when it is in the narcissistic range. The more addict the person the more dominant the narcissistic problematic.

The defective quality of bonding in early childhood comes either from excessive separation or too perfect symbiosis.

What is reassuring, is that the gamer is aware that “it is not real”, that the activity is fictional and unreal.

The game is a dual game. It belongs to the domain of “as if”.

> An addictive gamer spends on average thirtyeight hours per week online, whereas an average person only spends eight.

Everything is done to make children, adolescents and adults alike dependent on video games, when the game is launched the marketing ads are all about: “you will become addicted, you won’t be able to stop playing!”

Be careful at first, do not consider a geek as an addict, because he is first and foremost passionate about his computer activities. It is a style of life. He is passionate about computers, he fixes them up and loves technology.

The geek becomes dependent when the passion becomes an obsession, generating a disorganization of his family and social life. He withdraws from the rest of the world, only talks to other geeks, he becomes a pathological buyer, can lose his job and becomes incomprehensible except for those who share is virtual world.

GAMES IN GENERAL Today, society is all about being productive, and in reaction humans love to engage into this unproductive activity that is gaming.

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• Addiction: seeking sensations to fill-up a past void of emotions, • The need for sensations requires the presence of objects (products, at-risk behaviors) and an action, • The need for sensations is a condition for the escalation into addiction and dependence, • The addict is intolerant to waiting. He is permanently looking for the next episode, • The addict is not in the verbal language, since the latter triggers emotions, he is in the action producing sensations.

Parents, teachers and healthcare professionals are confronted to this problem of video games, whether alone or online with several players. It is the cultural activity that progressed the fastest these past years. It has become more important than both film or music industries. Gaming addicts represent 10 % of specialized consultations.

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Games are everywhere: smartphones, tablets, video consoles, television, computers, dedicated places (casino, bookies, etc). It cuts off or changes relationships between people. These games can be played in very different ways, which complicates the monitoring of at-risk patients.

Playing a game is an intermediate state between the self and the non-self, where objects lose their steadiness, change meanings and roles.

The majority of “no substance” addicts consult for gambling addictions.

In spite of the difficult economic situation, or because of it, people go on gambling because it is the last place one can still fulfill dreams.

For families, and especially in single-parent homes, parents have become dependent on their children (“spoiled children”) and unconsciously accept the fact that they stick with their addictions as long as they keep living at home within their family rather than becoming independent.

It is not a social ritual, but rather an individual ritual where the person proves his own existence by seeking his limits as witnessed by other people.

In these behaviors, death is not an objective.

They take the risk not in the optic of dying, but rather to push-off the limits of death.

EXAMPLES: suffocation games, glue sniffing, riding fast cars or bikes.

PROFILES OF AT-RISK PATIENTS It is never easy to ask an adolescent or adult about his addictions, regardless of the addiction, unless it is the reason for consulting.

Several discussion with my fellow physicians unveiled the difficulties encountered.

AT-RISK BEHAVIORS: PLAYING WITH DEATH SOME USEFUL COMMENTS Sometimes for the worse, people play with death to know the exaltation of still being alive. Adolescents who exhibit at-risk behaviors do not try to commit suicide, but they try to validate their legitimacy to be alive.

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Parents (…) accept the fact that their children stick with their addictions as long as they keep living at home within their family rather than becoming independent.”

• Therapeutic alliance is easier for us homeopaths, because we can adapt our interview and our attitude according to our

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patient’s Sensitive Type. For example: managed consolation with Pulsatilla, respectful distance with Sepia officinalis or Natrum muriaticum, precision and punctuality with Arsenicum album, etc.

• agoraphobia, • vertigo (fear of heights): fear of falling or to be crushed by a high building.

• We need to include questions on addictions during the comprehensive interview of our patients: we can sequence it with the food cravings and aversions, starting with the lesser of addictions (coffee  chocolate smoking, etc), those not bearing a guilty stigma for society.

His weakness can lead him to different types of addictions. He is a collector who, regardless of his addiction, adopts a meticulous and organized behavior. Everything will be organized in a precise order, with a ritual full of significance (which he keeps secrets), preserving him from his fear of disease and death.

COMORBIDITIES: • Obsessive Compulsive Disorders (OCD): washing up and checking everything, • Bipolar depression: alternation of periods of anxious agitation and depression with severe and deep fatigue.

• Very often our patients minimize their real consumption that could lead to an addiction.

When the therapeutic alliance is good, we should ask the question during another consultation.

• The care management should be a multidisciplinary one, the primary care physician remains the core person.

ANACARDIUM ORIENTALIS he has a hard time taking decision because he is ambivalent. His intellectual exhaustion is only improved by eating, thus he will develop eating disorders.

COMORBIDITIES: • addiction to video games, • bipolar depression, • eating disorders.

ANTIMONIUM CRUDUM what is important for him is to fill up. He has cravings for hard-to-digest food that he eats very fast and in large quantity.

He is a rude and crass patient, who does not respect himself or others. Antisocial personality.

COMORBIDITIES: • Eating disorders: hyperphagia, bulimia.

addiction to food, especially sweets, he eats in a feverish and hasty manner to appease his anxiety and fill up the void of his existence.

COMORBIDITIES: • claustrophobia,

AURUM He is a workaholic. When he is confronted to overwhelming professional difficulties. He will develop a feeling of indignation and despair that he expresses with disproportionate anger fits.

Comorbidities: • burnout, • depression with suicide attempts, • alcohol consumption, smoking, abuse of prescription drugs and other substances.

CALCAREA FLUORICA this patient is “twisted” physically and psychologically, he has an unstable behavior and takes decisions that suit him. He lacks sincerity, manipulates his world to the point of perversion. He is very preoccupied by money, and to fulfill his desires he can develop an addiction to gambling.

COMORBIDITY: • addiction to gambling.

COFFEA CRUDA for him, it is important to be positive, optimistic, and even euphoric. He can develop addictions to everything that his fun, if it gives him a feeling of exaltation.

COMORBIDITIES: • insomnia when falling asleep, with cardiac erythrism and overflow of positive ideas, • coffee abuse, • manic phase with euphoria in bipolar depression.

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ARGENTUM NITRICUM

ARSENICUM ALBUM

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IGNATIA AMARA His addictions vary, like all his symptoms that manifest in a paradoxical manner. These addictions will be amplified either to distract him, or when he is upset.

COMORBIDITIES • anxious disorders, • insomnia, • consumption of substances that can trigger the contrary of the expected effect.

LACHESIS MUTUS his main addictions (alcohol, at-risk sexual behavior, dating sites) are triggered or increased when he feels he is in danger in his affective or professional relationships. He then develops a feeling of jealousy, aggressiveness, anger, that he tries to compensate by his addictions.

In a woman, aggravation before menses.

COMORBIDITIES: • anxiety, • depression, • eating disorders: bulimia, • alcoholism.

NATRUM MURIATICUM is an adolescent or young adult who hides behind his addictions, or whose addictions isolate from the reality of the world.

COMORBIDITIES: • eating disorders: bulimia, anorexia, • drugs, mostly pot, • at-risk sexual behavior with ambivalence, • depression.

NUX VOMICA his addictions, to alcohol, drug or tobacco, are related to poor stress management, whether emotional or professional stress.

He puts himself in danger because of compulsive buying, “expensive and flashy”, high-tech or gadgets that he uses to put himself forward.

COMORBIDITIES: • burn-out, • at-risk behaviors: alcohol, smoking, substances, prescription drugs, extreme sports, • addiction to work.

LUESINUM profile of the fragmented adolescent, because he no longer has emotional landmarks and protects himself by being selfish.

He lacks structure and he is destabilizing.

COMORBIDITIES: • phobia of bacteria, contagious diseases, • OCD with washing up, • alcoholism.

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LYCOPODIUM CLAVATUM

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he is disabled by his misogyny and his misanthropy that he triggers and in which he is comfortable. His cold anger accentuates his isolation.

His main addictions are eating-related. His craving for sweets is based on mechanisms compensating for his frustrations, especially his sexual frustrations. They doubt his virility, in spite of an attraction for dating sites, where his fears put him in a situation of avoiding a concretization of his desire.

COMORBIDITIES: • anxiety, • depression, • eating disorders, • sexual behavior disorders: impotence.

PHOSPHORUS in this aesthete, giving the utmost importance to beauty and mind, the predominant addictions are collections of rare and precious things. He wants to be better than the others, even if it means losing himself in it and going bankrupt. He can compensate his losses by gambling.

He can also engage in risky sexual behaviors.

COMORBIDITIES: • burn-out, • depression, • nighttime eating binges, • sexual addictions.

PLATINA Behind a theatrical mask, she hides a personality dependent on the way people look at her. She does everything to please, sometimes putting herself in at-risk situations She will develop multiple addictions: • Compulsive buying for anything “that shines”,

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• fascination for at-risk sexual encounters, • wants to stay young: plastic surgery, exercising.

COMORBIDITIES: • eating disorders: anorexia, bulimia, • depression with suicidal risk.

PULSATILLA Her need to be loved at all costs and to remain in the world of dependence drives her to several childlike addictions (collecting dolls, trains sets, miniature cars, etc.).

Her lack of substance encourages her to mimic others to be loved (her partner or others).

These are reactional addictions, more by default than by desire: drug, alcohol, smoking, video games.

She collects sexual encounters with younger or older partners.

COMORBIDITIES: • eating disorders, • depression, • social anxiety.

SULFUR He is immature but hides it by his love of life and by being altruistic, he develops several addictions.

Adolescent he will try everything: at-risk behaviors, dangerous sports, life-threatening behaviors, substance abuse, violent video games. Adult, he will put himself in financial difficulties leading him to develop other addictions, such as gambling.

COMORBIDITIES: • bipolar depression, • burnout, • substance abuse.

THUYA OCCIDENTALIS His obsessive side, with nosophobia, pushes him to go from doctor to doctor and taking too many drugs. He is impaired by his inability to make a decision and the poor interpretation of his cenesthopathy. He will then develop an anxious-depressive syndrome due to the chronicity of his disorders. It is a source of concern for the physicians, and rightly so, and reinforces his worries about his health.

COMORBIDITIES: • anxious-depressive syndrome, • abuse of prescription drugs.

SEPIA OFFICINALIS He is a person of duty, who protects himself by seeking solitude, it can lead to the development of addictions that promote his social isolation: • reading, • intense sports (combat or ballet), • goth and violent video games, • at-risk behaviors.

COMORBIDITIES: • eating disorders: anorexia, bulimia, • depression, • burnout.

STAPHYSAGRIA

Unstable personality, running away from the real world by withdrawing into his imaginary world. He can develop any type of addiction, regularly switching from one to the next.

COMORBIDITIES: • bipolar depression.

REMARKS > It is recommended to systematically add to the medicine of the at-risk profile, the medicine Dopamine. > One medicine represent an issue because it can trigger addictions: This drug is called SIFROL®pramipexoledihydrochloride monohydrate, it is indicated in idiopathic Parkinson’s disease or restless leg syndromes. It induces impulsive actions especially for compulsive buying, gambling and sexuality. > It would be interesting to give dilutions of this substance in 15 CH, 5 pellets per day.

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He can develop all type of addictions when confronted to frustration, mandatory situations where he cannot express himself.

Comorbidities: • burnout, • eating disorders: to fit in with the grunge look of being waif-like, emaciated, • depression, • taking substances.

TUBERCULINUM

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Conclusion Detecting the profiles of at-risk patients is the key to anticipating, adapting the way we listen to our patients and giving them advice in a personalized manner.

“

Intolerance to frustration is the basis of all addictive pathologies.”

The care management requires a motivational interview in order to have the patient progress from the pre-contemplation stage (knowing) to the contemplation stage (wanting).

Intolerance to frustration is the basis of all addictive pathologies.

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In addictions, the patient dampens the principle of reality. Balance must be found between the principle of pleasure and the principle of reality.

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The individual reaction can lead us to other medicines targeted either on disrupted emotions, or on physical symptoms described according to the patient’s sensitive type and/or his reactional mode. We will then look for medicines used in the treatment of anxious disorders, reactional depression and insomnia. n

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EVERY6TH INTERNATIONAL CEDH CONFERENCE DAY

Actaea racemosa an update on the Materia Medica

BARCELONA 2017

Josette Nouguez, MD - France

A

new approach of the pathological targets in order to widen the array of clinical indications in: • gynecology, • rheumatology, • neurology.

n ORIGIN • Actaea Racemosa, actual botanical name, formerly called Cimicifuga racemosa.

• Cimicifuga: cimex = bug and fugere = chase away • Racemosa = in cluster.

It belongs to the Ranunculaceae family and is found in the Northeastern part of North America.

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The three sources of the Materia Medica TOXICOLOGY • In high doses, Actaea racemosa has neurotoxic

- Salicylic acid, precursor of Aspirin, - Alkaloids: cytisine responsible for spasmodic pain in the muscles and uterus (found also in Caulophyllum thalictroides), - Isoferulic acids, - Resins and sterols.

• To obtain the mother tincture we use the rhizome and dry roots.

PATHOGENESIS The first semiological targets of Actaea racemosa were listed in the study of pathogenesis in T. F. Allen’s Encyclopedia: 67 experimentation subjects including 12 women only, who yielded few gynecological symptoms.

• Its very rich pharmacology contains:

CLINICAL EXPERIMENTATION

- Triterpenoid glycosides with effects similar to estrogens: actein, cimicifucoside and one Isoflavone, Formononetin responsible for its elective action on the female genital system,

It was obtained via clinical observation and the use of the plant by Native Americans for centuries.

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effects.

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Pathogenic targets

• Tremors of the upper and lower limbs, • Pain in the extremities, • Agitated sleep with nightmares, anxiety,

FEMALE GENITAL SYSTEM

• Concentration disorders.

• Endocrine disorders like “hyperestrogenism”, • Premenstrual syndrome: - Mastodynia, - Sharp pain under the left breast, - Dysmenorrhea proportional to the blood flow.

• Intermenstrual pain syndrome with painful ovulation, • Menstruation disorders:

constant need to move,

3

Individual Reaction of the Patient (IRP) SENSATIONS : • Spasmodic, cramping pain, twitches, • Pain under the left breast, • Searing pain, • Unbearable neuralgic pain.

- Generally heavy, dark, painful menses, - Most often with many blood clots , - Irregular cycles: sometimes short, sometimes long.

• Violent pain going through the pelvis from one hip to the other and radiating to the thighs, • Pelvic heaviness (bearing-down) during the menses, numbness of the abdominal muscles, • Pelvic hypersensitivity.

MODALITIES : • aggravation : - by cold, - in the morning for the pain, - during menstruation.

• improvement: - by heat except for the headaches.

MUSCULAR SYSTEM • Stiffness and cramps: - Cervical spine, need to stretch the head backward, - Dorsal spine, aggravated when bending forward, - Lumbosacral spine radiating towards the thighs and hips, - Achilles tendon.

• Pain when applying pressure to the spinous process at the T4, T5, T6 level, • Unbearable spasmodic pain of the vertex: - radiating towards the eyes, which are congested, - radiating towards the eyeballs, - radiating over the entire head “as if the skull was too small” sensation of numbness, • Pain under the left breast, • Throbbing pain in the thorax, along the ribs, • Pain and numbness in the arms.

CONCOMITANT SIGNS: • The spinous process from T4 to T6 is tender

4

to touch.

Clinical indications and medicine interactions GYNECOLOGY INDICATIONS 15 OR 30 CH • PREMENSTRUAL SYNDROME (PMS) HYPERESTROGENIA WITH MASTODYNIA, PELVIC HEAVINESS

NEUROSENSORY SYSTEM

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• Unbearable neuralgic pain:

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- face, maxillaries, - entire head, - eyeballs, - from the occiput to the vertex with dizziness.

• Occipital headache radiating to the eyes, • Headache with sensation of plenitude of the vertex, bruising,

FOLLICULINUM 15 CH LAC CANINUM mastodynia,

NATRUM MURIATICUM mastodynia in a context of hyperestrogenia,

LACHESIS MUTUS context of hyperestrogenia, congestion, breast tensions,

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“

Clinical experimentation was obtained via clinical observation and the use of the plant by Native Americans for centuries.”

SEPIA OFFICINALIS

pelvic heaviness, but in a context of hypoestrogenia,

MUREX PURPUREA swollen breasts, pelvic congestion.

NATRUM MURIATICUM pain is conversely proportional to the blood flow,

CAULOPHYLLUM THALICTROIDES dysmenorrhea with painful expulsion of blood clots,

COLOCYNTHIS • INTERMENSTRUAL SYNDROME (IMS) WITH PAINFUL SPOTTING DURING OVULATION

NATRUM MURIATICUM IMS with albumin-like leukorrhea,

searing pain, improved by pressure, flexion,

PLATINA context of hyperestrogenia, short menstrual cycles, heavy periods with dark-red flow, spasmodic, cramping uterine pain,

PLATINA PMS and IMS with pain in the left ovary,

LACHESIS MUTUS

LACHESIS MUTUS heavy, even hemorrhagic periods, pelvic pain, improvement by the blood flow,

IMS and pain in the left ovary,

MUREX PURPUREA LAC CANINUM

short cycles, profuse periods with clots (hyperestrogenia).

• ENDOMETRIOSIS WITH SPASMODIC, CRAMPING PAIN, RADIATING • DYSMENORRHEA WITH HEAVY, DARK AND PAINFUL MENSES (pain shooting through the pelvis), frequent blood clots. The pain is proportional to the blood flow and improved by pressure.

TOWARDS THE PELVIS AND THIGHS

PLATINA endometriosis and ovarian pain.

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ovarian pain.

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• PELVIC HYPERESTHESIA

PLATINA contact genital hyperesthesia especially during intercourse or medical examination, genital pruritus,

• FACIAL NEURALGIA

ACONITUM NAPELLUS unbearable pain aggravated by cold,

CAUSTICUM grazing pain, like a raw wound, aggravated by cold.

MUREX PURPUREA congestion and pelvic hyperesthesia not decreasing the sex drive.

• POSTURAL CERVICODORSAL PAIN, SPINOUS PROCESS IS TENDER TO TOUCH

• MENSTRUAL HEADACHES, ESPECIALLY BEFORE THE MENSES

MAGNESIA PHOSPHORICA sharp, sudden, erratic, spasmodic pain,

LACHESIS MUTUS is improved by the onset of the menstrual flow,

LAC CANINUM

RHUS TOXICODENDRON tearing pain, aggravated by rest and improved by movements.

headaches, switching from one side to the next.

• LOW BACK PAIN AND SCIATICA • REGULATION OF LABOR, CERVICAL DYSTOCIA

PLATINA CAULOPHYLLUM THALICTROIDES will often be associated, • FOR IUD INSERTION by its action on vulvar hypersensitivity and uterine spasms, > One dose in 30 CH before the gesture.

• MENOPAUSE Hot flashes and depressive syndrome in menopause,

LACHESIS MUTUS congestive hot flashes, mood swings.

spasmodic pain aggravated by the slightest contact,

KALIUM CARBONICUM low back pain with sensation of weakness,

COLOCYNTHIS shooting, cramping pain with numbness, improved by heat,

MAGNESIA PHOSPHORICA cramping pain improved by heat,

RUTA GRAVEOLENS pain aggravated by rest, trauma to the sacrum,

> If Lachesis mutus fails think of Actaea racemosa.

RHUS TOXICODENDRON pain aggravated by rest.

RHEUMATOLOGY INDICATIONS 15 OR 30 CH JANUARY 2018 CEDH MAGAZINE

• TORTICOLLIS, CERVICOBRACHIAL NEURALGIA

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LACHNANTHES TINCTORIA contractures of the cervicodorsal hinge and cervical neuralgia,

MAGNESIA PHOSPHORICA sharp, searing pain radiating towards the face, jaw.

• ACHILLES TENDINITIS

RUTA GRAVEOLENS tendon pain, nodules on the tendons,

SYMPHYTUM OFFICINALE following periosteal trauma,

AMMONIUM MURIATICUM sensations of retracted tendons, tendons too short,

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CAUSTICUM tendinitis with sensation of tendons too short, walks on tiptoes.

LACHESIS MUTUS insomnia with dreams of death, burial, agitation.

• ALTERNATION OF LOQUACITY PHASES ASSOCIATED WITH SEVERE ANGER AND MUTISM PHASES

NEUROSENSORY INDICATIONS 15 OR 30 CH

PLATINA is most often compared on its similarity,

• CERVICODORSAL NEURALGIA (HEADACHES) RADIATING

SEPIA OFFICINALIS

TOWARDS THE TOP OF THE HEAD AND EYEBALLS

GELSEMIUM SEMPERVIRENS

can also be brought up for its mood swings, oversensitivity, disgust for life,

ophthalmoplegia headaches and migraines, muscle relaxant action,

SANGUINARIA CANADENSIS congestive headaches going from the occipital region to the supraorbital region,

PLATINA spasmodic pain, hypersensitive to the slightest touch.

• HEADACHES WITH SENSATION OF PLENITUDE OF THE VERTEX AND RADIATING OVER THE ENTIRE HEAD

GELSEMIUM SEMPERVIRENS occipital headache radiating towards neck muscles, sensation of plenitude of the head.

LACHESIS MUTUS presents with phases of mutism, withdrawal and phases of hyperactivity.

• FEAR OF LABOR AND DELIVERY: FEAR OF NOT BEING ABLE TO GIVE BIRTH TO A BABY, FEAR FOR THE BABY

5

Conclusion • We will remember that Actaea racemosa plays an important role in hormone dysfunctions in women during their reproductive years and perimenopause.

• It is also an important medicine in rheumatology and in neurology for men and women alike.

• TINGLING IN THE UPPER AND LOWER LIMBS, TREMORS

• REGARDLESS OF THE PATHOLOGY WE WILL KEEP IN MIND THE

GELSEMIUM SEMPERVIRENS

KEYWORDS THAT CAN BE SEEN IN ALL INDICATIONS

tremors and myasthenia,

MAGNESIA PHOSPHORICA ain and cramps in the upper limbs after repetitive gestures.

BEHAVIORAL INDICATIONS 15 OR 30 CH

• Spasmodic pain, • Cramping pain, • Searing, sharp pain, • Radiating pain.

• IT HAS ITS PLACE ALONGSIDE

aggravated by cold, • INSOMNIA WITH NIGHTMARES, AGITATION, ANXIETY

KALIUM BROMATUM insomnia with terrors, sleepwalking, psychomotor agitation,

• Platina for spasms, cramping radiating pain, and hyperesthesia,

• Causticum for unbearable, searing pain aggravated by cold without having the following: “stiffness, retractions, regression”.

JANUARY 2018 CEDH MAGAZINE

• Aconit for neuralgia with sudden sharp pain

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6TH INTERNATIONAL CEDH CONFERENCE

Actaea racemosa, an update on the Materia Medica

BARCELONA 2017

6

Actaea Racemosa clinical case

• The examination shows contractures of the cervicodorsal spine with pain to pressure on the spinous process at the T4 to T5 level.

• TREATMENT FOR ONE MONTH

MARIE, 30, CONSULTS FOR OCCIPITAL HEADACHES AND CERVICODORSAL PAIN

• She gave birth 6 months ago and is breastfeeding her baby.

• Pain started two months ago and increases with each breastfeeding session.

• At the beginning the pain was localized on the cervical spine and was aggravated by rest and improved when Marie was exercising.

• Today she feels “like a weight” on her vertex, contractures on the upper spine and she cannot find any comfortable position to breastfeed.

• Cervicodorsal spine pain alternates with low-back pain, the pain shoots along the ribs, the arms that get numb and towards the eyes.

n Actaea racemosa 30 CH: 5 pellets 3 times a day • Occipital headache radiating towards the eyes, • Postural pain when breastfeeding, • Cervicodorsal contractures with pain radiating to the ribs, arms (numbness), top of the head, • Sleep disorders with nightmares and agitation. n Arnica 15 CH: 5 pellets morning and evening • Sensation that the bed is too hard, bruising. n Rhus toxicodendron 15 CH: 5 pellets morning and evening • Pain aggravated by rest and improved by movement.

• At night, sensation that the bed is too hard, bruising.

• Her sleep is also disrupted by nightmares; she feels the need to move all the time. She says she is irritable and at times she does not want to see anyone.

• Upon waking up she is all stiff, warming up is long

JANUARY 2018 CEDH MAGAZINE

and difficult .

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AFTER 15 DAYS MARIE FEELS MUCH BETTER and can continue breastfeeding without any problems. n

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