Homeopathic TreatmentofEpidemic Influenza

©2006, 2009 Eric Udell, N.D.

Historical Perspective

©2006, 2009 Eric Udell, N.D.

Early Success in Treatment of Epidemic Diseases

Hahnemann and homeopathy first gained fame in Europe as a result of successful treatment of epidemics.

©2006, 2009 Eric Udell, N.D.

Scarlatina Epidemic (1799)

Hahnemann’s first use of homeopathy in an epidemic.

Birth of genus epidemicus & homeopathic prophylaxis.

©2006, 2009 Eric Udell, N.D.

Typhus Fever (1813)

Hahnemann cured 178 of 180 cases

Allopathic mortality rate was 20-30%

©2006, 2009 Eric Udell, N.D.

Epidemic vs. Pandemic

Epidemic: An infectious disease affecting an unusually large number of individuals at the same time in a region or locality where the disease is not permanently present.

Pandemic: An epidemic affecting a wide geographic area, such as an entire country or the entire world.

©2006, 2009 Eric Udell, N.D.

Epidemic Influenza

Occurs annually, generally in a single wave in late winter.

Kills approximately 30,000 people in the U.S. in an average year, with an additional 10-15,000 deaths every few years.

©2006, 2009 Eric Udell, N.D.

Pandemic Influenza

20th Century Pandemics:1918 – Spanish Flu (H1N1)1957 – Asian Flu (H2N2)1968 – Hong Kong Flu (H3N2)

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Spanish Flu 1918-19(Taubenberger JK. The Origin and virulence of the 1918 “Spanish”influenza virus. Proc Am Philos Soc. 2006 March; 150(1): 86-112.)

≈675,000 deaths in U.S.≈40 million deaths worldwide.25-30% of global population infected.2.5% mortality.0.1% typical influenza mortality.H1N1 2009 ≈ 1.12% mortality. (http://www.who.int/csr/don/2009_09_04/en/index.html)

©2006, 2009 Eric Udell, N.D.

Spanish Flu 1918-19Highest mortality rates in ≈20-40 year olds.Leading causes of death: � 2° bacterial pneumonia.� Massive pulmonary hemorrhage or pulmonary

edema very shortly after initial onset of symptoms.

©2006, 2009 Eric Udell, N.D.

Mortality in Pneumonia

Pre-antibiotic era: Allopathy 20 - 40%.

(Bartlett JG, Mundy LM. Community-acquired pneumonia. NEngl J Med. 1995 Dec 14;333(24): 1618-24.)

Modern era:Community-acquired 5.1 - 36.5%

(Michael J. Fine, MD, MSc; Melanie A. Smith, MPIA; et al. Prognosis and outcomes of patients with community-acquired pneumonia. JAMA. 1996;275(2):134-141.)

Homeopathy < 1% (http://www.homeopathy.ca/articles_det01.shtml)

©2006, 2009 Eric Udell, N.D.

Pandemic Influenza: Who’s at greatest risk?(http://www.cdc.gov/media/pressrel/2009/r090729b.htm)

Pregnant womenChildren 6 months to 4 years, especially those less than 6 monthsChildren 5-18 years with chronic health conditionsAdults 25-64 years with chronic health conditions or compromised immune systems

©2006, 2009 Eric Udell, N.D.

Why Homeopathy?

©2006, 2009 Eric Udell, N.D.

Homeopathy & Spanish Flu(Dewey WA. “A Chorus of Fifty in Harmony.” Journal of American Institute of Homeopathy, 1920.)

Dean W.A. Pearson of Philadelphia collected 26,795 cases treated by homeopathic physicians with a mortality rate of 1.05%.

1,500 cases reported at the Homeopathic Medical Society of the District of Columbia with 15 deaths. Recoveries in the National Homeopathic Hospital were 100%.

G.B. Stearns collected over 17,000 cases through the International Hahnemannian Association with a mortality of 4%.

©2006, 2009 Eric Udell, N.D.

Homeopathy & Spanish Flu(Dewey WA. “A Chorus of Fifty in Harmony.” Journal of American Institute of Homeopathy, 1920.)

30 physicians in Connecticut responded to H.A. Robert’s request for data. 6,602 cases reported with 55 deaths, which is less than 1%.

11 men reported 3,600 cases with 6 deaths (0.16%).

©2006, 2009 Eric Udell, N.D.

Homeopathy & Spanish Flu(Dewey WA. “A Chorus of Fifty in Harmony.” Journal of American Institute of Homeopathy, 1920.)

One physician at a Pittsburgh hospital asked a nurse if she knew anything better than what he was doing, because he was losing many cases. “Yes, Doctor, stop Aspirin and go down to a homeopathic pharmacy, and get homeopathic remedies.” The Doctor replied, “But that is Homeopathy.” “I know it, but the homeopathic doctors for whom I have nursed have not lost a single case. “ W.F. Edmundson, M.D., Pittsburgh.

©2006, 2009 Eric Udell, N.D.

Conventional Vaccine

The groups CDC prioritizes for vaccination in the U.S. total 159 million people (http://www.cdc.gov/h1n1flu/vaccination/acip.htm)

45-52 million doses expected sometime in October (Chicago Tribune, 9/08/09)

Goal to deliver 200 million doses

©2006, 2009 Eric Udell, N.D.

Resistance to Antivirals

Only handful of Tamiflu resistant cases of H1N1 Swine flu reported so far

However, increased resistance is possible as number of H1N1 influenza cases increases, use of anti-viral drugs increase, & virus mutates.

©2006, 2009 Eric Udell, N.D.

Homeopathic Prophylaxis

1) Nosodes

2) Genus Epidemicus

Taylor, W. On the Genus Epidemicus. Whole Health Now Website (www.wholehealthnow.com).

©2006, 2009 Eric Udell, N.D.

Nosodes

©2006, 2009 Eric Udell, N.D.

Represent epidemic disease in generic form

Do not account for individual variability

Influenzinum for influenza

•

Nosodes: Evidence in FavorJonas W, Dillner DK. Protection of mice from Tularemia infectionwith ultra-low, serial agitated dilutions prepared from Francisella Tularensis-infected tissue. Journal of Scientific Exploration 14(1): 35-52.

Used 3d, 7d, 14d, 30c, 200c, & 1000c potencies vs. controlAll potencies except 1000c were protective; only 30C and 200C potencies produced anti-tularensis antibody formationNosode reduced mortality by 22%, delayed death by 5 days, & tripled number of organisms required to kill 50% of animalsNosode less effective than conventional vaccine

©2006, 2009 Eric Udell, N.D.

Nosodes: Evidence in FavorCastro D, Nogueira GG. Use of the nosode Meningococcinum as a preventative against meningitis. Journal of the American Institute of Homeopathy, 1975 Dec 68(4): 211-219.

1974: Guaratingueta, Brazil; Meningitis epidemic in region since1971.Meningococcinum 10CH single dose (made from strains A & C)Data refers to children < 15 years of age:18,000 vaccinated 4 cases 0.022%6,364 unvaccinated 10 cases 0.16%Based on infection rate in non-vaccinated group, 28.8 cases expected in treatment group if nosode did not provide protectionDuration of protective effect at least 3 months.

©2006, 2009 Eric Udell, N.D.

Nosodes: Evidence in Favor

©2006, 2009 Eric Udell, N.D.

Mroninski C, Adriano E, Mattos G. Meningococcinum: It’s protective effect against meningococcal disease. Homeopathic Links. Vol. 14, Winter 2001: 230-234.

1998: Blumenau, Brazil; Meningitis endemic in regionMeningococcinum 30CH single dose (made from tissue sample taken from boy who died of Type B Meningitis in Blumenau)Vaccination program focused on children ages 0-20 years65,826 vaccinated 1 case 0.0015%23,532 non-vaccinated 7 cases 0.0029%Protection again meningitis 95% over 6 months, 91% over 1 year

Nosodes: Posology

Poor evidence base to make decisionTraditional practices extremely variableEvidence available suggests:

Longer duration of protective effect using 30c and above1000c (= 1M) potency in Tularemia study did not have protective effect at all

Consider 30c or 200c weekly during epidemic

©2006, 2009 Eric Udell, N.D.

Genus Epidemicus

Based on law of similars

Identification of remedy whose symptoms are most similar to the epidemic in its differentiated form

Surest approach to homeopathic prophylaxis

©2006, 2009 Eric Udell, N.D.

Scarlatina Epidemic (1799)(Dudgeon RE. Lectures on the Theory and Practice of Homeopathy, 1854. )

10 allopathic physicians treated 1,646 children prophylactically with Belladonna123 (7.4%) developed symptomsInfection rates were as high as 90%

©2006, 2009 Eric Udell, N.D.

Genus EpidemicusOrganon, Aphorism 101

Usually the physician does not immediately perceive the complete picture of the epidemic in the first case that he treats, since each collective disease reveals itself in the totality of its signs and symptoms only after several cases have been closely observed.

©2006, 2009 Eric Udell, N.D.

Genus EpidemicusOrganon, Aphorism 102

From writing down the symptoms of several cases of this sort, the outline of the disease picture becomes more and more complete—not more extensive and wordy, but more characteristic, containing more accurately the peculiarity of the particular collective disease.

©2006, 2009 Eric Udell, N.D.

Genus EpidemicusOrganon, Aphorism 102

The ordinary symptoms—e.g., loss of appetite, sleeplessness, etc.—become more precisely qualified, and those that are more exceptional, special, and in the circumstances, unusual, and belong to only a few diseases, reveal themselves and constitute the characteristic picture of this epidemic.

©2006, 2009 Eric Udell, N.D.

Genus Epidemicus

Can be used both for prophylaxis and to treat active disease

May be more than one genus epidemicus remedy:

Can change over course of epidemicCan vary from one region to another

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Treatment of Active Disease

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Principles Guiding the Approach to Treatment

Like cures likeIndividualizationCharacteristic symptoms

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Treatment of Active DiseaseTaking the Case:

Investigate the symptoms that represent an alteration in the normal daily functioning of the patient

Symptoms representing the person’s chronic disease state are of relatively little value

©2006, 2009 Eric Udell, N.D.

Treatment of Active DiseaseTaking the Case:

Objective: to identify the individualizing features of the epidemic disease as it manifests in this individual, i.e., the characteristic symptoms.

©2006, 2009 Eric Udell, N.D.

Characteristic SymptomsOrganon 153

In this quest for a homoeopathic specific remedy, i.e., in comparing the totality of symptoms of the natural disease with the symptom lists of available medicines so as to find a disease agent similar to the trouble being treated, the more striking, strange, unusual, peculiar (characteristic) signs and symptoms in the case are especially, almost exclusively, the ones to which close attention should be given,

©2006, 2009 Eric Udell, N.D.

Characteristic SymptomsOrganon 153

because it is these above all which must correspond to very similar symptoms in the symptom list of the medicine being sought if it is to be the one most suitable for cure. More general and indefinite symptoms, such as loss of appetite, headache, weakness, troubled sleep, discomfort, etc., if not more precisely qualified, deserve little attention, because one finds something general of the kind in almost every disease and almost every medicine.

©2006, 2009 Eric Udell, N.D.

Influenza: Common Symptoms (http://emedicine.medscape.com/article/219557-overview)

Incubation period: 18-72 hoursFever (≈100°-104°F) & chillsMyalgiasFrontal/retro-orbital headacheRed & watery eyesRhinitis (discharge is commonly absent)Sore throatWeakness & fatigueCough, chest pain on coughing, dyspneaNausea, vomiting, & diarrhea (less common)

©2006, 2009 Eric Udell, N.D.

Materia Medica

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GelsemiumSlow onset (Bry)Intense fatigue & prostration; dull, cannot think; sleepyDull appearance with dusky flushing of facePartial ptosis; photophobia.Heaviness throughout body—head, eyelids, limbs.

©2006, 2009 Eric Udell, N.D.

Gelsemium

Trembling, including tongue (Lach, Merc)Fever: Low-grade or high-gradeChills run up & down back (Mag-p, Bapt, Ars)Skin moist, hot, & sticky; coldness of extremitiesDesire to lie still and quiet; does not want to make any effort; < movement (Bry)

©2006, 2009 Eric Udell, N.D.

Gelsemium

Mouth & lips dry, yet thirstless (Puls)Headaches (may be severe):

Begins in occiput; spreads down into neck causing stiffness and up and over skull to forehead; heavy or throbbingTight band around head

©2006, 2009 Eric Udell, N.D.

BryoniaSlow onset (Gels)Heavy, dull, despondentGeneralized aching pain, may be severe< Motion (all sxs.) (Bell)Irritable, ill humor, especially when disturbed (Nux-v, Ph-acid); desires to be still & quiet (Gels)

©2006, 2009 Eric Udell, N.D.

BryoniaHot, uncomfortable in a warm room, desire for cool air (but can be chilly)Sweat, often profuseIntense thirst for cold waterPains > pressure, lying on painful side; warm applications (rheumatic pains)Cough: painful, must hold chestFaintness, vertigo on sitting up in bedAnxiety about business, poverty; difficult to please

©2006, 2009 Eric Udell, N.D.

Eupatorium perfoliatumSEVERE, deep-seated, aching pains; as if bones broken or joints dislocated < during heat stage of fever, motion (Bry)Incessant restlessness due to the pain (Rhus-t, Ars)Moaning & groaning from the painChilly

©2006, 2009 Eric Udell, N.D.

Eupatorium perfoliatumChill preceded by insatiable thirst for cold water, but cold water may cause nausea & bitter vomiting; thirst remains through all fever stagesChill begins in back; intense shivering, returns at slightest uncovering (Nux-v); bilious vomiting during or at close of chill; chill followed by intense heatSweat scanty or absent; if profuse, relieves all sxs., except headache, which can be severe; eyeballs painfulCough: painful, must hold chest (Bry); > getting on hands & knees

©2006, 2009 Eric Udell, N.D.

Nux vomicaChilly, sensitive to slight drafts and uncoveringSensitive to light, noise, odors, touch, painIrritable, impatient, easily angered, especially when questioned or disturbed (Bry, Ph-ac)

©2006, 2009 Eric Udell, N.D.

Nux vomica

Fever: predominated by chill, < slightest uncovering (Eup), remains covered during heatRhinitis: nose obstructed in cool, open air; runs indoors in warm roomScratchy throat > warm drinksGI:

Sour & bitter eructations Nausea with desire to vomit but cannotConstipation or diarrhea with frequent ineffectual urging > after passing even a small amount

©2006, 2009 Eric Udell, N.D.

Nux vomica

Ineffectual urgings to vomit, stool, urinateInsomnia: cannot fall asleep or wakes at 3 a.m. and cannot return to sleep due to thoughts, especially of business or daily affairs; from slight noise

©2006, 2009 Eric Udell, N.D.

Rhus toxicodendron

Slow onsetLower temperaturesSevere, generalized aching causing extreme restlessness> Change of position, motion< at rest, muscles become stiff & painful when still

©2006, 2009 Eric Udell, N.D.

Rhus toxicodendronChilly, very sensitive to cold; < cold, slightest draft (Ars, Nux-v, Eup-perf)Fever with profuse sweat; heat & burning felt internally, yet skin surface cold; as if hot water coursing through blood vessels (Ars, Bry)Exhausted, prostratedSleepless due to pain & restlessness; sleep disturbed by vivid dreamsAnxious & apprehensive; depressed, despairing, weepy

©2006, 2009 Eric Udell, N.D.

Rhus toxicodendron

Painful, herpetic eruptions on lips; urticaria & other itching skin eruptionsCough from irritation in trachea; hoarsenessCoated tongue with red, triangular tip

©2006, 2009 Eric Udell, N.D.

Mercurius

Face bright red with damp, oily-looking sweatProfuse, hot, perspiration, which does not relieve, may even produce aggravation< night, warmth of bed

©2006, 2009 Eric Udell, N.D.

Mercurius

Intolerance of either extreme of temperature; too warm when covered, chilly when uncoveredTongue swollen, flabby, pale, coated, trembling; takes imprint of teeth; tendency to fissure & ulcerate; profuse, viscid, sticky saliva; breath offensive; metallic taste in mouth; painful ulcerationsThroat dusky, dark, red; hot & burning; swallowing painful

©2006, 2009 Eric Udell, N.D.

Mercurius

Speech hurried, impeded, difficult, stutteringIntense conjunctivitis; profuse lachrymation with hot, burning tears, excoriate cheeks; marked photophobiaProfuse, water, acrid nasal discharge excoriating upper lip; burning in nose; violent attacks of sneezing < open air or warm roomHurried, impatient; anxious, restless; homesickness; desire to travel

©2006, 2009 Eric Udell, N.D.

Arsenicum album

Great prostration, debility, wearinessBurning pains, parts burn like fire > warmthExcessive anxiety, great anguish, extreme restlessness, fear of death > companyChilly > external warmth

©2006, 2009 Eric Udell, N.D.

Arsenicum album

Chill irregular, intermingled with heat or alternating with heat; followed by intense, dry heat with inclination to uncover; sweat rare, if present is scant, cold, & clammyUnquenchable thirst for cold drinks, drinks little & often; may vomit immediately after drinking< 12-3 a.m.Discharges acrid, burning, offensiveDiarrhea after eating or drinkingExcessive exhaustion from least exertion

©2006, 2009 Eric Udell, N.D.

Additional RemediesAconiteArum triphyllumBaptisiaBelladonnaCausticumChinaHelodermaKali bichromicumPhosphorusPyrogenium

SiliceaSticta pulmonariaSulphurRemedies commonly used to treat:

PneumoniaPulmonary hemorrhagePulmonary edema

©2006, 2009 Eric Udell, N.D.

Posology

Match the pace & severity of the disease.

More severe and rapidly progressing diseases will typically require a more aggressive posology.

©2006, 2009 Eric Udell, N.D.

Posology

High potenciesMore likely to result in aborting the disease process; Or at least to move patient through disease course more rapidly

(Borland, DM. Pneumonias, 1939.)

©2006, 2009 Eric Udell, N.D.

Posology: Repetition of the Dose

More rapidly progressing diseases will typically require more frequent repetition of the dose.

©2006, 2009 Eric Udell, N.D.

Case Management: Changing Remedies

If the patient is improving, do NOTchange the remedy (or the potency).

If improvement stops or a relapse occurs, first consider increasing the potency of the same remedy.

©2006, 2009 Eric Udell, N.D.

Case Management: Changing Remedies

Only change the remedy if:

You have given a higher potency without further improvement.

New symptoms have emerged that clearly indicate a new remedy.

©2006, 2009 Eric Udell, N.D.

Case Management: Adjunctive Therapies

Diet:Rule of thumb is to generally respect the patient’s natural inclinations for food and drink.

• “…in acute diseases, the awakened instinct of the patient is often considerably wiser than the physician who does not consult nature in his prescriptions. “

• Hahnemann, S. Are the obstacles to certainty and simplicity in practical medicine insurmountable? The Lesser Writings, 1852.

Hydration is clearly important, especially during high fever.

©2006, 2009 Eric Udell, N.D.

Case Management: Adjunctive Therapies

Must make a clinical judgment based on your confidence as a homeopathic prescriber and case manager.

Hydrotherapy:• Helpful adjunct in pneumonia &

respiratory diseaseBotanicals?Nutritional Supplements?Manipulation?Pharmaceuticals?

©2006, 2009 Eric Udell, N.D.

Resources

http://www.cdc.gov/H1N1FLU/http://www.who.int/csr/disease/swineflu/enhttp://www.hersculaboratoryflu.org/http://nationalcenterforhomeopathy.org/services/fluforum/index.jspBorland DM. Influenzas, 1939.Borland DM. Pneumonias, 1939.Pulford A, Pulford D. Leaders in Pneumonia, 1928.

©2006, 2009 Eric Udell, N.D.