Dolichos pruriens: A Case
Report
Vladislav Ivantsov,
M.D.
(Russian version)Prehistory of this case:
When I found an information in the homeopathic literature about
the remedy Dolichos pruriens, I just remembered one patient in the
gastroenterologic department who was suffering from the cirrhosis of
liver, and that disease was accompanied with unbearable skin itch. As I
know, there is no specific effective allopathic remedy or method of
treatment (Cholestipol – the intestinal sequestrant of cholic acids, which
was practically ineffective in this woman) of skin itch in this condition
(so called, the syndrome of cholestasis, which is related with
accumulation of cholic acids in skin layers, provoking unbearable skin
itch).Therefore, I decided to prove clinically the ability and
effectiveness of this remedy in treatment of skin itch in some hepatic
patients with syndrome of cholestasis.The criteria for selection of such patients were:
* chronic affection of liver (hepatitis, cirrhosis),
* skin itch, due to liver disease.
These patients are quite rare in practice. Then, I found
the appropriate case of woman with cirrhosis of liver, who treated
herself, regularly, for many years in the gastroenterologic department.Mrs, M.G.V.
Age: 47 years old.
Disability: She is a disabled woman, due to her liver
disease.Date of the first consultation of a homeopath:
15.02.2001Diagnosis:
Chronic cholestatic hepatitis, activity of third degree, with
progressive development, hormone needed, with hepatocellular insufficiency
of second degree, with transformation into cirrhosis of liver. Syndrome of
portal hypertension of first degree. Syndrome of cholestasis with
intensive constant itch of skin.The basic complaints:
1. The intensive, unbearable, “terrible” itch
of skin (the symptom with three underlinings), which is especially worse
in evening at 9 p.m. and nights hours.Localization: the heels, feet, toes, palms, epygastric
region, back, eyes, inside of nose (it is provoking the sneezing), in
mouth, but the most intensive itching – in the lower and upper
extremities.She does not sleeps normally at night due to itching of
skin during last year. There are no any measures, any treatment, those may
liquidate this symptom. There is only some amelioration from a hot bath,
but after a half of hour this itch is increasing again. She often use the
special bristle brush with a long handle, in order to reduce the intensity
of itch. After scratching the intensity of itch is diminishing slightly.
She made an attempts to bathing with salt baths and shower of different
temperatures – but it was in vain.Recently, after a treatment at hospital, skin itch is
slightly diminishing. This symptom is not accompanied with any eruptions.2. The great general weakness.
3. Her blood pressure is decreasing usually, in range
of: Systolic pressure 110 – 80, Diastolic pressure 70 – 50 mmHg, and she
is suffering from vertigo and headache usually when her blood pressure at
the level of 80/50 mmHg.4. During the last week there was a fever with
increasing of body temperature until 39 C, then it was stabilized
spontaneously.5. The intensive pains in both hypochondriac regions,
tearing, dull, burning: “As if from the nettle”. The dull pain
under the angle of right scapula: “As if there the abscess under the
skin”. This pain is more intensive under the scapula rather than in
right hypochondrium. This is a chronic pain, since 1995. It is not
depending from eating, and it is worse from the deep breath. This pain is
extending, “shooting” trough the right hypochondrium to the back
and right scapula.6. The constant yellow colour of the eyes.
7. The massive deposits of cholesterine around the eye
lids – the so called “ksanthoma”, of yellow colour. It is
increasing quickly, since 1996 (due to increased level of cholesterine in
serum).8. The pains of dull character in joints: the knees,
elbows, worse at walking and when she is descending down stairs.
Arthralgia – since 1998.9. The bitterness in the mouth, during all the day.
10. The great dispnea from walking.
11. Stool constipated (after her first childbirth).
Stool of white colour, resembling a white clay. A hemorrhoids, one nodus
with bleeding.12. The intensive thirst for drinks (she is drinking
about 1 liter in a day).Anamnesis morbi:
She was suffered from long-lasting subfebrile periodic fever
with increasing of body temperature until 37,5 C, since 1973, with unknown
cause. She feels herself hot, and does not freeze in room in winter, she
usually open the windows for the fresh air.Since 1990 she is suffering from intensive pains in the
stomach region (there was diagnosed gastritis), which worse from eating of
fatty and fried food. The belting pains (from the back to the
hypochondrium) was appeared since 1991.The disease of the liver was recognized actually since
1994. The onset of disease resembled an Acute Respiratory Infection with
fever until 38,7 C. – she was hospitalized in the infectious clinic with
suspicion of Hemorrhagic Fever with Nephritis Syndrome (that is an endemic
infectious disease in region, where she lives), but later this diagnosis
wasn’t confirmed.There have been revealed an increasing of hepatic tests,
but all of markers of virus hepatitis was negative. Therefore, infectious
aetiology of liver disease has not been confirmed. Since this time she is
consulting regularly by the gastroenterologist and infectionist.Now she is receiving the repeating courses of treatment
in the gastroenterologic department: Prednisolonum: 25 – 15 mg/daily,
Asatioprinum 1 tabl/daily, hepatoprotectors, vitamins, infusion therapy,
but the laboratory tests are still remains high increasing (AST, ALT,
Alkaline Phosphatase, Bilirubin). In spite of the treatment, the skin itch
isn’t disappear practically. She wasn’t healed herself earlier by any of
the homeopathic remedies.Background of the disease:
There was a surgery in 1996 – cholecystectomy, because
of the gall-stone. There wasn’t any improvement after this surgery.The Table N1: “The results of the laboratory
tests”Abbreviations: High increased – (h.i.), Increased –
(i.), Decreased – (d.), Slightly decreased (s.d.), Normal – (N), “The
former analyses maximum until:” – (max.)Date: 12.02.2001
__
RBC: 3,8 x1012 l. (d.)
HB = 114 g/l. (d.)
Colour Index = 0,9 (N)
Thrombocytes = 190 x109 l. (N)
WBC: = 13 x109 l. (h.i.)
differential blood count:
neuthrophiles = 64%
limphocytes = 24%
monocytes = 7%
ESR = 54 mm/hour (h.i.)
Time of bleeding = 2,30 min. (N)
Time of coagulation = 4,45 min. (N)
Index of Prothrombine = 89% (s.d.)
Fibrinogen = 7,32 g/l. (h.i.)
Glucose = 2,88 mmol/l. (d.)
Bilirubin:
Total = 71 micromol/l. (h.i.) (max. 170 micromol/l.)
Direct reacting bilirubin = 48 micromol/l. (h.i.)
Indirect reacting bilirubin = 23 micromol/l. (i.)
Cholesterinum = 11,8 mmol/l. (h.i.) (max. 15 mmol/l.)
Amylase = 263 Eu/l. (N)
Urea = 4,5 mmol/l. (N)
AST (aspartat aminotransferase) = 124 Eu (N = until 31 Eu) (h.i.)
ALT (alanine aminotransferase) = 32 Eu (N = until 30 Eu) (s.i.) (max.
186 Eu)
GGTP (gammaglutamil transpeptidase) = 1887 Eu (N until 40 Eu) (h.i.)
Alkaline Phosphatase (the marker of cholestasis) = 1195 Eu (N until
306 Eu) (h.i.)__
Analysis of the case history:
Therefore, taking into account the following symptoms:
* The unbearable skin itch due to the liver disease with
syndrome of cholestasis (i.e: from accumulation of cholic acids in the
skin layers, those provokes itching),* The skin itch without any eruptions.
* Aggravation of itch at the evening and night hours.
* Aggravation from the contact with water.
And the symptoms for the second remedy:
* A chronic pain, during many years, under the lower
angle of the right scapula, (the keynote – symptom for Chelidonium)* The pains extending, “shooting” through the
body from the right hypochondrium to the back and the right scapula.* Yellow colour of eyes.
* The constant bitterness in the mouth.
I selected two homeopathic remedies, which were planned
to alternate one with another, according to the presence of the symptoms:
in the case of skin itchiness – Dolichos, in the case of pains under the
scapula – Chelidonium.The rubrics of Kent’s Repertory for Dol., which are
appropriate for this case:Skin, itching: Dol.++
Skin, itching, night: Dol.++
Skin, itching, eruption without: Dol.++
Skin, itching, scratching agg.: Dol.++
Skin, itching, warm on becoming: Dol.++
Skin, burning, night: Dol.++
Skin, colour, yellow, jaundice: dol.+
The rubrics from R.S. Phatak’s Repertory (1.): (in small
print)Itching, in jaundice: dol., hep., myrica, pic-ac.,
ran-b., thyr.Itching, eruptions without: alum., ars., cist., cupr.,
dol., mez., thyr.
The differential diagnosis:
There are another similar remedies in M.M., those
correspond also to the main symptoms of this case: “the skin itch in
patients with jaundice” and “pain under the scapulae”:The most similar remedy (with both symptoms): Myrica
cerifera.Back, pain, aching, dorsal region, scapulae, under:
CHEL. +++, myrica +There is no Myrica in Kent’s rep. in rubrics for skin
itching, but W.B. wrote: “Skin: Yellow and itching. JAUNDICE.
Extremities: Pains under the scapulae and in the nape of neck”.Abdomen, flatulence: myrica +
This is a characteristic symptom of Myrica, which is
absent in this case – W.B.: “Stool: the constant passing of
intestinal gases during walking”.Fagopyrum. – this remedy provoke skin itch with
eruptions.W.B.: “Skin: ITCHING, amel. from washing with cold
water, agg. from scratching, from touching. Painful red spots, vesicles
and pustules, phlegmonous dermatitis. ITCHING OF HANDS. The skin is hot
and swelling”.Extremities, itching, (hand, upper, lower limbs) fago. +
Thyreoidinum.
W.B.: “Skin: jaundice with itching. Skin itching
without eruptions, which aggravates in night”. There is no other
similar symptoms for this case.Hepar sulphuris.
Skin, itching, jaundice, during: Hep ++. W.B. didn’t
emphasized this symptom in his M.M.Therefore, after the analysis of M.M., I think that skin
itch of Dol. is much stronger than of Myrica’s one.The first homeopathic prescription: 15.02.2001
1. Rx: Dolichos pruriens 6 cH – 10.0
One dry dose (5 pills) sublingually with repeating of
dose when it is necessary, at the returning of skin itch.2. Rx: Chelidonium 6 cH – 10.0
One dry dose (5 pills) sublingually with repeating of
dose when it is necessary, at the appearing of pains under the right
scapula.Follow – up 1 (consultation by phone): 16.03.2001
There was a positive effect from using of Dolichos
pruriens 6 cH: a considerable decreasing of the intensity of the skin
itch, but it must be noticed, that amelioration from one single dose (5
pills) of 6 cH potency was very short: only 40 – 60 minutes, then skin
itch was gradually increased again, and after subsequent dose of remedy
shortly ameliorated again.It was a real improvement, seemed to me, because I felt
it from the behaviour of woman, from her joyful mood – that was the first
time, when she felt an amelioration from that skin problem, which is
lasting many years. All vial of remedy have been spended during 1 month.
There wasn’t a necessity for the second remedy – Chelidonium, because
there wasn’t a pains under the scapula.Considering this case since her first visit as a
palliative only, because of long history of the disease and irreversible
deep organic changes in the liver, those proved by the laboratory tests,
ultrasound scanning of the liver and even by laparoscopy during the
surgery in 1996 which revealed uncommon yellow colour of liver, long
treatment with cytostatics and corticosteroids, I decided to follow up
this case with using of low potencies of homeopathic remedies, and then to
make an attempt to increase the potency with estimation of it
effectiveness.The second homeopathic prescription: 16.03.2001
Rx: Dolichos pruriens 30 cH – 10.0
One dry dose (5 pills) sublingually with repeating of
doses when it is necessary – at the returning of skin itch.Follow – up 2 (by phone): 23.04.2001
She is using Dolichos 30 cH, at the same time with her
usual allopathic treatment, and now the length of amelioration from one
dose is about 80 minutes, then is appearing the picture, described above –
the relapse of itching with amelioration from following doses of the
remedy. The second remedy – Chelidonium 6 cH was really effective and the
pain under the right scapula disappeared after it.Conclusion:
The nature of the liver disease in this case is rather
of auto-immune character, because of negative results of hepatitis viruses
markers. Taking into account the deep organic changes in the liver,
suppressive allopathic treatment with hormones and cytostatics, without
stabilizing of laboratory tests and clinical picture, I consider this case
as incurable (from the homeopathic viewpoint). Perhaps, the following
increasing of potency (e.g.: 200 cH) may bring any improvement, but it may
be related with an aggravation from the homeopathic remedy, due to deep
organic changes (As wrote J.T. Kent in his “Lectures on Homeopathic
Philosophy”, lect. n37). That was why I decided to prescribe her a
low potencies of two remedies as at the beginning of the treatment, of
course, with her usual allopathic medicines. The meaning of this case is
that Dolichos is effective remedy in healing of skin itch in hepatic
patients, but it may be more effective in another cases without deep
organic changes.The third homeopathic prescription: 23.04.2001
1. Rx: Dolichos pruriens 6 cH – 10.0
The same method as above
2. Rx: Chelidonium 6 cH – 10.0
The same method as above
Now she is receiving this treatment with temporal
amelioration of the skin itch.Summary:
It was a palliative case – history of long-lasting
hepatitis with a syndrome of cholestasis and with unbearable skin itch.
This symptom was ameliorated temporarily by using of low potencies of the
“small homeopathic remedy”: Dolichos pruriens 6 cH, 30 cH. The
second remedy was Chelidonium 6 cH, which I selected with using a keynote
symptom; it was effective in healing of the pain – syndrome, which was
characteristic for this remedy.The brief information from Materia Medica about
Dolichos:Dolichos pruriens (L.),
Synonyms: Stizolobium pruriens Medic., Mucuna pruriens
(DC)Botanic family: Fabaceae (Leguminosae).
English common names: Cowhage, Cow-itch.
French: Pois a gratter or pouillieux, Ceil de bourrique,
Deutch: Juck-borsten, Kratzbohnen, Kuhkratze.
Parts Used: The hairs of the pod, seeds.
Habitat: Tropical regions, especially East and West
Indies,Tropical America, Brazil, Micronesia, Fiji, Tahiti.
(5.) “Mucuna pruriens is a leguminous climbing
plant, with long, slender branches, alternate, lanceolate leaves on hairy
petioles, 6 to 12 inches long, with large, white flowers, growing in
clusters of two or three, with a bluish-purple, butterfly-shaped
corolla”.“Fruit a large pods or legumes, hairy, thick, and
leathery, averaging 4 inches long, are shaped like violin sound-holes, and
contain four to six seeds. They are of a rich dark brown colour, thickly
covered with stiff hairs, about 1/1O inch long”.The first homeopathic proving of this remedy (Dolichos 2
cH) made by Dr. Jacob Jeans in 1851 (North American Journal of
Homeopathy).The active biological substance of this plant is
contains in the hairs of bean – it is a pruritogeneous protease, which is
provoke in provers the intensive skin itch when it penetrate the skin.This remedy is caused also another characteristic
symptom in provers: the pain on the right side of internal throat, under
the angle of lower jaw “As if a splinter were embedded
vertically” (similar remedies: Arg-n., Hep., Nit-ac., Sil.)The detailed description of this remedy you may find in
W. Boericke’s, T.F. Allen’s, Clarke’s Materia Medicas.(2.) The intensive skin itch, which is not accompanied
by the eruptions or swelling. The yellow spots around all the body. The
intensive skin itch at night, also in jaundice. Neuralgia after herpes
zoster. Skin itch is ameliorates from the cold water, but it caused a
burning of skin and trembling.(3.) “Right – sided” remedy. The basic is the
INTENSIVE SKIN ITCH, without eruptions, worse at night. White stool.
Constipation. Enlargement of liver. Jaundice.(4.) Intensive skin itch around all the body, without
eruptions, jaundice, white stool.References: See the chapters: Dolichos pruriens, Myrica
cerifera, Chelidonium majus.1. Phatak R.S., M.B.B.S. “A Concise Repertory of
Homoeopathic Medicines” Second edn. New Delhi India B. Jain
Publishers 1977.2. Phatak R.S., M.B.B.S. “Materia Medica of
Homoeopathic Medicines” New Delhi India B. Jain Publishers 1977.3. Boericke W., Boericke O. “Materia Medica with
Repertory” 9th edn. New Delhi India B. Jain Publishers.4. Nash E.B. “Leaders in Homoeopathic
Therapeutic” Philadelphia “Boericke & Tafel” 1913.5. William Cook, M.D. “The Physiomedical
Dispensatory”, 1869.More information about the plant Dolichos pruriens, some
Internet web – links:http://www.hear.org/pier/stpru.htm – PIER homepage.
http://www.dfw.gov.mp/stizolob.htm – Photos of the plant – Stizolobium
pruriens.
http://www.botanical.com/botanical/mgmh/c/cowha111.html – Cowhage.
The brief description:
The clinical case of a “small homeopathic remedy” Dolichos
pruriens in the palliative treatment of the intensive skin itch in patient
with a syndrome of cholestasis.Keywords: Skin itch, Cholestasis, Hepatitis, Dolichos pruriens,
Palliative treatment.Abbreviations: M.M. – Materia Medica, W.B. – Materia Medica of William
Boericke.
Copyright
(c): Vladislav Ivantsov, 2002.