Homeopathy (2008) 97, 206–213

Ó 2008 The Faculty of Homeopathy

doi:10.1016/j.homp.2008.08.002, available online at http://www.sciencedirect.com

CLINICAL

Homeopathic practice in Intensive Care Units:

objective semiology, symptom selection and
a series of sepsis cases
MZ Teixeira1,*, SM Leal, VMFA Ceschin
1
Department of Clinical Medicine, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil

Abstract: Homeopathy has been used for more than two hundred years to treat chronic
disease using various approaches in a wide range of diseases. However, for acute disease
and critical illness, application has been limited by inadequate training of homeopathic
physicians and the small number of pertinent clinical studies. In view of the difficulty of
practising homeopathy in Intensive Care Units (ICU), a protocol was developed to facili-
tate description of objective homeopathic symptoms with a ranking of symptoms appro-
priate for these situations (Protocol for Objective Homeopathic Semiology). Examples of
favorable results with individualized homeopathic treatments for a series of cases of Sys-
temic Inflammatory Response Syndrome (sepsis) are described. Homeopathy (2008) 97,
206–213.

Keywords: Homeopathy; Acute disease; Critical illness; Homeopathic semiology;

Intensive care units; Sepsis

hemodialysis and, hemofiltration, enteral and parenteral

feeding, metabolic monitoring and control etc.), prolonging
‘‘Why not offer this as the test of our ability and skill,
survival for periods and in conditions unknown to Hahne-
and consciously admit that we must abort all acute dis-
mann’s time. Education of homeopathic physicians in the
eases or cease to call ourselves homeopathicians?’’
treatment of acute diseases and critical cases is deficient
(James Tyler Kent, Lesser Writings, Higher use of
because of the lack of experience; a knowledge gap is re-
primary branches in medical education)
sponsible for the inability and fear of treating acute episodes
or acute flare ups of chronic processes.
Because of the altered state of consciousness or impossi-
Introduction bility of communications with critically ill patients, classic
In its 200 year history of homeopathy, treatment of homeopathic anamnesis cannot identify the symptoms pe-
chronic disease has become increasingly import, enabling culiar to the sick individual. This requires a different semi-
a holistic approach and improving the patient-physician re- otic technique. In acute clinical manifestations, the various
lationship with a therapy free of collateral effects. But little types of homeopathic symptoms demand a specific weight-
is known about the use of homeopathy in critical cases. ing to find the correctly individualized medicine.
Modern science has greatly improved life support for these Homeopathic practice in Intensive Care Units (ICU)
patients (mechanical ventilation, cardio-circulatory support, faces patients on the verge of life and death, with little
time to act, few characteristic homeopathic symptoms and
many variables that complicate the initial approach and
*Correspondence: Marcus Zulian Teixeira, Department of Clinical the evaluation of the homeopathic therapeutics.
Medicine, Faculty of Medicine, Universidade de São Paulo, São With increasing dissemination worldwide of various
Paulo, Brazil. types of complementary and alternative medicine
E-mail: marcus@homeozulian.med.br
Received 4 December 2007; revised 15 June 2008; accepted (CAM),1–3 homeopathy should be used as a complementary
6 August 2008 treatment4 in all fields of medicine.
 Homeopathic practice in ICU
MZ Teixeira et al
207
Specific questions concerning useful in determining the choice of the remedy’’ (Organon,
paragraph 95).6
homeopathyandacuteillness To measure the importance of these objective aspects in
Some questions are frequently raised: the homeopathic semiology of critically ill ICU patients, we
identified many signs and symptoms that may be derived
(i) Is it possible to reconcile individualized homeopathic from a conventional clinical history, physical exam, diag-
therapy with conventional therapy and invasive proce- nostic exams and direct observation of the patient and his
dures of intensivist practice? attitudes, described in the homeopathic repertory.7 These
(ii) Can homeopathy contribute in critical extreme states or are distributed as follows: Mind (213 rubrics), Head (62),
is it too late to recover health and equilibrium of vital or- Eye (105), Ear (44), Nose and Smell (83), Face (93), Mouth
gans? (112), Teeth (42), Throat (74), External Throat (41), Stom-
(iii) How can information be obtained from a patient who is ach (53), Abdomen (80), Rectum (56), Stool (83), Bladder
unconscious or in an altered state of consciousness? (35), Kidneys (10), Prostate gland (12), Urethra (35), Urine
(iv) Which symptoms should be emphasized and used in the (33), Male genitalia (80), Female genitalia (77), Larynx and
assessment of the critically ill patient? Trachea (40), Respiration (43), Couch (182), Expectoration
(v) What parameters should be used to evaluate response to (75), Chest (108), Back (57), Extremities (147), Nails (40),
therapeutic homeopathy in these cases? Sleep (36), Chill (90), Fever (91), Perspiration (89), Skin
(vi) How does one work with homeopathic doses and dilu- (72), and Generalities (258). The Protocol for Objective
tions? Homeopathic Semiology is available online.8
In addition to critically ill patients, application of this tech-
nique to chronic patients stimulates recognition of character-
Objectives istics not detected by classicical homeopathic anamnesis.
This increases the likelihood of detecting indicators for mi-
To elaborate a semiotic technique, the Protocol for Ob- nor medicines which present rare peculiar and characteristic
jective Homeopathic Semiology for patients with an altered symptoms, which could be diagnosed with this protocol.
state of conscience.
To propose a system of evaluation and selection of ho-
meopathic symptoms, in critically ill patients. Literaturereview
To enhance responses to homeopathic treatment with We found few references in homeopathic literature to
a series of cases of ICU patients with Systemic Inflamma- treatment of critically ill patients. However, based upon
tory Response Syndrome (SIRS). that which already existed for acute cases, we highlighted ba-
sic steps in the semiotic approach to acute, critical patients.
Objective Homeopathic Semiology Hahnemann
For patients who have difficulty in reporting their symp- In paragraph 73 of The Organon,6 Samuel Hahnemann
toms (unable to talk, low level of consciousness), use of classified acute diseases by categories, emphasizing the sig-
objective symptoms is of fundamental importance. In inten- nificance of biopathographical causalities (nutrition, phys-
sivist homeopathy, a normal search for objective symptoms, ical, climate, intellectual, psychic or emotional ailments
without a protocol or system to follow is difficult. Several etc.) with the ability to trigger an acute process such a ‘‘tran-
bedside visits to the patient often do not identify any pecu- sient explosion of latent psora’’. He also referred to acute
liar manifestation. Lack of knowledge of signs and objec- diseases caused by contagion, which can affect a large num-
tive symptoms described in homeopathic Materia Medica ber of susceptible individuals in a similar way (epidemic),
and repertory is one of the main obstacles for identification and acute miasms, that always return in the same form.
of important symptoms in these patients. In paragraphs 18 and 154 of The Organon,6 the impor-
In view of this, a Protocol for Objective Homeopathic tance of the characteristic symptomatic totality correct
Semiology was developed for all systems and regions of choice of homeopathic medicine for chronic as well as acute
the body, to help detect characteristic signs and symptoms diseases was emphasised. In paragraphs 82, 99 and 152–154,
in critical ill patients who are unable to report their suffering the semiotic approach to acute cases is covered to men-
because of intubation, unconsciousness, extreme weakness, tioning the ‘‘more striking, singular, uncommon and pecu-
etc.5 liar (characteristics) signs and symptoms’’, stressing that
By classifying these objective characteristics according anamnesis is ‘‘only partially applicable to acute diseases’’.
to regions of the body or chapters of the repertory, it be-
comes possible to distinguish signs and peculiar symptoms Kent
rarely spontaneously mentioned by patients because they In chapters III and XXXIII of Lectures on Homeopathic
express aspects that the person finds difficult to observe Philosophy,9 James Tyler Kent, refers to acute miasms (eg.
and note in himself, ‘‘partly because the patients become diphtheria, typhoid fever, scarlet fever), orients choice to-
so used to their long sufferings that they pay little or no wards medicines specific to the common clinical condition
heed to the lesser accessory symptoms, which are often (medicines that reflect the pathognomic symptoms of dis-
very pregnant with meaning (characteristic) - often very ease, grouped under a repertory rubic with the name of

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 Homeopathic practice in ICU
MZ Teixeira et al
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the disease) and applying differential diagnosis with spe- Table 1 Hierarchization of homeopathic symptoms in serious
cific symptoms at a given moment. acute cases
In chapter XXVI,9 like Hahnemann, Kent distin- (1) Etiological, clinical and anathomo-pathological diagnosis.
guishes the semiotic approach to chronic and acute (2) Usual and pathognomic symptoms of the acute disease with
typical modalities.
diseases, stressing that chronic symptoms and acute (3) Local, mental and general symptoms which emerged or suffered
symptoms should not be mixed, orienting the prescrip- modification with acute disease.
tion for a group of specific symptoms that comprise (4) Symptoms or causalities that triggered the acute disease
(biopathographical symptoms).
the image of the acute illness: ‘‘the symptoms of acute
attack are separate and autonomous’’.
In his Lesser Writings, Kent emphasized that selec-
tion of medicines in acute cases, such as typhoid fe-
Case series:Systemic Inflammatory
ver10 and diphtheria 11 should take the following Response Syndrome (SIRS)
sequence: (1) grouping of medicines related to the Examples of the homeopathic approach to the critically
pathognomic symptoms of the acute disease (common acute patient follow, according to the premises cited, with
symptomatic totality); (2) individualization of the a series of cases of patients with Systemic Inflammatory Re-
medicine by seeking symptoms for each specific case sponse Syndrome (SIRS) in ICU, who received combined
(characteristic symptomatic totality). conventional and individualized homeopathic treatment.14
‘‘How to treat the patient suffering acute and serious dis- All were admitted to the ICU of Hospital Amico, Uni-
ease’’, Araújo12 summarized the main points of the Kentian dade Vila Mariana (São Paulo, Brazil), between May and
approach for acute conditions: September, 1999. According to the guidelines of the Ethics
(1) begin with pathognomic symptoms of that individual Committee of the Hospital, the next of kin and those respon-
acute disease (or of a group of patients, in the case of sible for the patients consented to the homeopathic ap-
an epidemic); proach. Choice of patients for homeopathic intervention
(2) from the repertory identify the homeopathic medicines was based upon recognition that they were not responding
able to produce this clinical condition; satisfactorily to conventional treatment as judged by the at-
(3) add the general symptoms of the patient (or of each pa- tending ICU medical team. Homeopathic treatment was be-
tient in the case of an epidemic); gun after the normal corrective and supportive measures
(4) add the specific symptoms and modalities; (maintenance of the affected vital organs) and treatment
(5) finally, include mental symptoms, but only those ap- of the primary focus (antibiotic therapy, surgical removal
pearing during the acute stage, Kent suggested, for acute etc.). Conventional therapy was not modified or substituted
cases 1 M and 10 M at 4 to 6 h interval, until improve- by homeopathy. Homeopathic evaluation included medical
ment. chart data (causal disease, triggering factors, concurrent as-
pects etc.), information from the patient (when conscious
Eizayaga
and willing to speak) and the definition of objective signs
and symptoms at bedside. The symptoms were selected
In his work Treatise on Homeopathic Medicine, 13
for the repertory according to the hierarchization model
Francisco Xavier Eizayaga proposes an approach sim-
for acute cases described above. The Clinical Homeopathic
ilar to Kent, in which the choice and weighting of
Materia Medica was use to confirm individualized homeo-
symptoms of acute illness differ from those of chronic
pathic medicine for each case.
conditions.
Medicines were given in Hahnemann centesimal (cH) di-
Emphasizing that homeopathic semiology in acute cases
lutions with an initial sequence of 6, 30 and 200 cH, to re-
must be faithful to the ‘‘actual similitude’’, he cites the fol-
duce the number of variables that could influence
lowing as necessary for success acute cases:
assessment of results had we used a wider range of poten-
(1) clinical and etiological diagnosis; cies. In most cases, treatment was begun with a 30 cH, con-
(2) pathognomic and common symptoms of the acute dis- sidered by James Tyler Kent as a ‘‘low enough to begin
ease with its characteristic modalities, restricted to the business in any acute or chronic cases’’.9 Continuation or
medicines identified in the 1st stage; change of medicine and the interval between doses was de-
(3) mental, general and local symptoms that appeared or termined by individual evaluation of each case according to
were modified in the acute process; Objective parameters of therapeutic homeopathic evalua-
(4) symptoms or effects that may have favored emergence tion (Table 2).
of the acute process (meteorological, microbial, nutri-
tional, physical, chemical etc.).
Case 1: Sepsis – Gastro–Intestinal Tract Focus
HF female, 74 years, weight 70 kg.
Summary of the authors Summary of clinical medical history: attended at Hospital
In summary, in critically ill patients, these authors Amico – Accident and Emergency Department (Vila Ma-
advocate seeking the actual characteristic symptomatic riana Unit), on 06/05/99 at 03h20 with history of abdominal
totality, with the hierarchization of homeopathic pain of colicky character, in epigastrium, followed by eruc-
symptoms (Table 1). tation. She denied any alteration of intestinal rhythm.

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Table 2 Objective parameters of therapeutic homeopathic 17h00 (07/05/99) – Acute atrial fibrillation with fast ven-
evaluation tricular rate (200 bpm) after visit of relatives whom she rec-
(1) Central Nervous function: level of consciousness and orientation ognized and contacted by signs. Received antiarrhythmic
in time and space. agent (Amiodarone), with reversion to sinus rhythm. Anti-
(2) Respiratory function: breathing mechanics and arterial
gasometry. biotics: Imipenem-cilastatin and Vancomycin chloride.
(3) Cardio-circulatory function: cardiac frequency and rhythm, Nasogastric tube drained 900 ml.
arterial pressure and indirect tissue perfusion (acid-base
equilibrium). Homeopathic evaluation 18h30 (07/05/99):
(4) Renal function: hourly urinary output by weight and follow-up of
serum levels of scoria (urea and creatinine).
(5) General evolution: intensity of habitual and necessary (1) Etiological, clinical and anatomo-pathological diagnosis:
alo-enantiopathic therapy. GENERALITIES – Septicemia, blood poisoning.
(6) Others: complementary exams. (2) Usual and pathognomic symptoms of disease with typical
modalities:
GENERALITIES – Pulse - discordant with temperature.
(3) Local, mental and general symptoms, which emerged or suffered
modification with the acute disease:
Physical examination: MOUTH – Smooth, shining, glazed, glistening, glossy tongue.
MOUTH – Discoloration - tongue, red.
Central Nervous System: conscious, oriented, with no (4) Symptoms or causalities which triggered the acute disease
neurological alterations. (biopathographical symptons):
Respiratory System: eupneic, non-cyanotic, normal pul- ABDOMEN – Inflammation.
GENERALITIES – Wounds - dissecting.
monary auscultation. GENERALITIES – Wounds – dissecting - ailments from.
Cardio-circulatory System: rhythmic pulse; normal heart
frequency; BP = 150/80 mmHg.
Abdomen: flaccid, painful to palpation in the epigas- Repertorization7:
trium, hydro-aerial bowel sounds.
Initial treatment: antispasmodic agent in continuous so- 1. GENERALITIES – Septicemia, blood poisoning.
lution and observation. 2. GENERALITIES – Pulse - discordant with temperature.
Re-examined at 04h40 (06/05/99): unchanged. 3. MOUTH – Smooth, shining, glazed, glistening, glossy
Management: opiate analgesic (Tramadol chloride) and tongue.
histamine H2-receptor antagonist (Cimetidine). 4. MOUTH – Discoloration - tongue, red.
Admitted to hospital at 05h30, she received analgesic all 5. ABDOMEN – Inflammation.
day, with no improvement; an abdominal ultrasonography 6. GENERALITIES – Wounds - dissecting.
was requested but not done. 7. GENERALITIES – Wounds – dissecting - ailments from.
01h00 (07/05/99): aggravation of pain in spite of analge-
sics. Dyspneic, hypotensive (100/60) and tachycardic Homeopathic Symptoms Total Symptoms
(120 bpm); abdomen with abrupt decompression + and dis- Medicines covered weight
1 2 3 4 5 6 7
tension. Abdominal x-ray shows pneumoperitoneum.
Examined by General Surgeon and submitted to explor- Pyrog 7/7 16 3 3 2 2 3 2 1
atory laparotomy. Ars 5/7 13 3 2 3 3 2
Lach 5/7 13 3 3 2 3 2
Surgical finding: perforated duodenal ulcer, with intense Apis 5/7 12 2 2 3 3 2
peritonitis, purulent secretion in cavity. Crot-h 5/7 10 3 2 2 2 1
Hypotensive (60/40), tachycardic, metabolic acidosis, Ter 5/7 10 1 2 2 3 2
Phos 4/7 10 2 2 3 3
even with precautive correction. Rhus-t 4/7 9 2 1 3 3
Resection and suture of duodenal borders carried out. Arg-n 4/7 5 1 2 1 1
11h15m (07/05/99) – Admitted to ICU Acon 3/7 7 2 2 3
Somnolent, still under anesthetic effect, opened eyes
when stimulated. Homeopathic prescription: Pyrogenium 30 cH, single
Physical examination: hypothermic (T axillary = 35.0  C), dose of 5 drops.
pale, dehydrated, feeble and accelerated pulses, oliguresis; Continued conventional therapy, Noradrenaline (0.6 mg/h)
‘‘although in shock state, her tongue was more moist than nor- introduced.
mal’’. After 06 hour (07/05/99 at 24.00):
Intubated, mechanical ventilation with FiO2 = 0.7 (70%) Temp. = 37.5 C; Heart rate (HR) 120 bpm,
and saturation of O2 = 96%. MAP = 68 mmHg; Diuresis = 2 ml/kg/min (880 ml/6 h).
Heart rate 130 bpm; mean arterial pressure No change in physical examination, except pulses, which
(MAP) = 45~50 mmHg with Dopamine 10 mcg/Kg/min. were ample and with increased perfusion.
Investigation
Metabolic acidosis equalized; Urea = 82 mg/dl, Creati- After 12 hour (07/05/99 at 06.00):
nin = 1.2 mg/dl; 4.700 leukocytes with a shift to metamye- Temp. = 37 C; HR 82 bpm, MAP = 89 mmHg (Dopa-
locytes; Coagulation: APTT = 40% (16 sec./ INR = 1,8). mine 8 mcg/kg/min and Noradrenaline 1 mg/h);
Hepatic enzymes (GOT, GPT) normal. Diuresis = 2.3 ml/kg/min (980 ml/6 h); Nasogastric
Clinical diagnosis: Septic shock (abdominal focus). probe (NGP) = drained 100 ml in 12 h.

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After 18 hour (08/05/99 at 12.00): pathology. Physical examination: Hypoxia with intense dysp-
36 C; HR 85 bpm, MAP = 96 mmHg (continued Dopamine nea, despite use of Venturi mask with FiO2 50%; tendency to
and Noradrenaline); diuresis = 1.6 ml/kg/min (700 ml in 6 h); hypotension; crepitations in lower 2/3 of both lungs: increased
NGP = 20 ml; ventilation: decreased FiO2 to 0,3 (30%). peripheral perfusion; tendency to hypothermia; oliguresis.
Agitated, wanted to leave ICU to go home, conscious and
After 24 h (08/05/99 at 18.00): oriented, easy to communicate, refuses to be alone in room
36.9 C; HR 80 bpm, MAP = 99 mmHg (same vasoactive and afraid of dying.
drugs); diuresis = 3.3 ml/kg/min (1,400 ml in 6 h); NGP = 0. Investigations: Chest x-ray, consolidation in lower 1/3 of
New episode of arrhythmia: (acute atrial fibrillation) dur- right lung and diffuse interstitial infiltrate of remaining fields,
ing visit of relatives, sedated. bilaterally; Leucocytosis and severe left shift; oliguresis and
After 48 h (09/05/99 at 18.00): raised serum urea (129 mg/dl) and creatinine (2.1 mg/dl).
36.8 C; HR 77 bpm, MAP = 97 mmHg (drugs main- Clinical diagnosis: Bilateral interstitial pneumonia; Acute
tained); diuresis = 2.6 ml/kg/min (4,450 ml in the last Respiratory Failure and Acute Renal Failure; Systemic Inflam-
24 h); NGP = 0. matory Response Syndrome [Defined as two or more of the fol-
lowing criteria: (1) Temperature > 38 C or <36 C; (2) Heart
After 96 h (11/05/99 at 18.00): rate (HR) > 90 bpm; (3) Respiratory rate (RR) > 20 ipm or
Normal temperature, HR, MAP; extubated for 10 h; with PaCO2 < 32 mmHg; (4) Leukocyte count > 12,000/mm3,
no vasoactive drugs for 10 h; diuresis = 3.3 ml/kg/min < 4,000/mm3 or > 10% immature cells]
(5,680 ml in 24 h), with only maintenance hydration Previous history: Beta-blocker since 1995 (Atenolol) and
(3,000 ml/ 24 h). Liquid diet was introduced. ACE inhibitor (Captopril); Diabetes controlled with diet;
obese (113 kg for 1.53 m).
Discharge from ICU on 14/05/99, light oral diet. Antibi- 11/05/99: brief improvement, requiring only non-invasive
otics stopped on 17/05/99. mechanic ventilation (CPAP mask) with high FiO2 (80%).
Discharge from hospital on 19/05/99. Homeopathic evaluation 10h00 (11/05/99):
Evaluation by ICU team:
Recovery of functional alterations of committed organs (1) Etiological, clinical and anatomo-pathological diagnosis:
occurred in 48 h, a fact not usually observed in cases of GENERALITIES – Septicemia, blood poisoning.
acute abdomen with Peritonitis, especially in older patients. (2) Usual and pathognomic symptoms of disease with typical
modalities:
Digestive system had recovery similar to elective surgeries None
without complications in vital organs. Of interest was the (3) Local, mental and general symptoms, which emerged or suffered
occurrence of full and prolonged polyuria (diuresis more modification with the acute disease:
MIND – Anxiety - bed, in – tossing about, with.
than 2 ml/kg/hour) without excess hydration, and even after MIND – Anxiety – bed, in – driving out of.
return of serum creatinine to the normal level. MIND – Fear, apprehension, dread – death, of.
MIND – Company – desire for, aversion to solitude.
Case 2: Sepsis – Pulmonary Focus GENERALITIES – Weakness – restlessness, with.
(4) Symptoms or causalities that triggered the acute disease
WG male, 53 years, weight = 110 kg. (biopathographical symptons):
Summary of clinical medical history: Attended Hospital CHEST – Inflammation – Lungs.
Amico – Accident and Emergency Department (Vila
Mariana Unit), on 05/05/99 complaining of colicky lumbar Repertorization7:
type pain, with radiation to right flank and associated nau-
sea that did not improve with antispasmodics (Scopolamine 1. GENERALITIES – Septicemia, blood poisoning.
butylbromide). 2. MIND – Anxiety - bed, in – tossing about, with.
Physical examination: physical examination was normal, 3. MIND – Anxiety – bed, in – driving out of.
except: BP 230  130 mmHg and positive Giordano’s sig- 4. MIND – Fear, apprehension, dread – death, of.
nal in the right lumbar region. 5. MIND – Company – desire for, aversion to solitude.
Kept in observation and examined by Urology with ten- 6. GENERALITIES – Weakness – restlessness, with.
tative diagnosis of acute pyelonephritis. Pain ceased (anal- 7. CHEST – Inflammation – Lungs.
gesia) and patient was discharged next day 06/05/99.
Homeopathic Symptoms Total Symptoms
Return to Accident and Emergency 08/05/99: Medicines covered weight
1 2 3 4 5 6 7
Patient was transferred to ICU 09/05/99 with Acute Ars 7/7 19 3 1 3 3 3 3 3
Respiratory Failure. Rhus-t 5/7 12 3 2 2 3 2
Puls 5/7 11 3 2 2 2 2
10/05/99: clinical history was taken again and patient re- Nit-ac 5/7 9 2 1 1 3 2
ported that his illness began 8 days before with generalized Bry 5/7 9 3 1 1 2 2
Carb-v 5/7 9 3 1 1 1 3
malaise during a flu epidemic, but without typical symptoms Ph-ac 5/7 8 2 1 2 2 1
of influenza. He became symptomatic and after 3 days Phos 4/7 11 3 3 3 2
without improvement felt chest pains worse on breathing Lyc 4/7 10 3 3 2 2
Acon 4/7 9 3 1 3 2
and dyspnea. No symptoms of cardiopathy or digestive

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211
Homeopathic prescription: Arsenicum album 30 cH, sin- Abdomen: normal.
gle dose of 5 drops. Skin: petechiae over entire body.
Conventional treatment continued. Investigations: cerebrospinal fluid; one cell, zero erythro-
cytes, negative reactions (proteins), negative bacterioscopy;
After 24 h (12/05/99): normal sinus x-ray; normal chest x-ray.
Normal temperature; HR 85 bpm (used beta-blocker Management: Admitted, received only symptomatic
at home); BP = 170  100 mmHg (without anti-hyper- drugs, and remained under observation.
tensive); RR 30 breaths/min, with Venturi mask at 3 h after admission: numerous episodes of diarrhea,
50% and peripheral saturation = 94%; diuresis 900 ml dehydration, somnolence; peripheral perfusion worsened;
every 6 h, with the same alteration of the renal func- petechiae and hemorrhagic suffusion over the entire body
tion. Calm, showing significant amelioration. (livedo reticularis).
Homeopathic prescription: repeat a single dose of Arsen-
icum album 30 cH. Admitted to ICU (12/06/99 18h30):
Physical examination: unconscious, in septic shock; ab-
After 48 h (13/05/99): sence of all pulses, except the carotids which were too
Normal temperature; HF = 80 bpm; BP = 190  100 weak (+/4+); petechiae disseminated, including conjuncti-
mmHg; RR 23 breaths/min (idem) and saturation 95%; Pol- val; without nape rigidity; severe cyanosis (purple lips);
yuric (2,000 ml every 6 h), recovering renal function. hypoxemic (gasometry and peripheral saturation); tachycar-
After 72 h (14/05/99): dic (HR 170 bpm); local vasodilatation in the face, with
Normal temperature; HR 80 bpm; BP = 140  100 intense hyperemia.
mmHg (without anti-hypertensives); RR 16 breaths/min, Management: Intubated and ventilated with FiO2 at
saturation 97%, with nasal catheter of O2 at 2 l/min; Polyuric 100%; central venous catheter inserted and vigorous
(more than 2,000 ml every 6 h), renal function normalized. volume expansion. In 4 h received: 0.9% NaCl
Discharged from ICU. 1,000 ml, Ringer’s lactate 1,500 ml, Gelatin solution
500 ml, and Albumin 500 ml. Even with many vigor-
After 6 days discharged from hospital: ous volume expansions, shock was maintained. Arterial
After completing antimicrobial treatment and with normal puncture unsuccessful.
investigations (Echocardiogram, chest x-ray to follow-up At 21 h: Dopamine (20 mcg/kg/min), Cefitriaxone
evolution, hemograms, renal function, hepatic function). sodium 1 g, Hydrocortisone succinate 300 mg, Fentanyl,
IV initiated due to extreme agitation.
Return to outpatient clinic 07/06/99: Coagulogram: APTT increased and low APT.
No complaints, clinically well, BP = 160  100 mmHg Clinical diagnosis: Meningococcemia, critically ill
[Atenolol 100 mg/day]. Normal chest x-ray. Advised in
controlling obesity. Homeopathic Evaluation 22h00 (12/06/99):
Evaluation by ICU team: During the first two days of
ICU, before homeopathic treatment, patient showed a slow
improvement which was not maintained. Hypoxemia rever- (1) Etiological, clinical and anatomo-pathological diagnosis:
sion occurred after 48 h of homeopathic treatment with nor- FEVER - Cerebrospinal fever.
GENERALITIES – Septicemia, blood poisoning.
malization of the respiratory and cardio-circulatory (2) Usual and pathognomic symptoms of the disease with typical
parameters, permitting ICU discharge. Arterial pressure modalities:
was controlled in ICU without use of anti-hypertensives. HEAD - Congestion, hyperemia.
SKIN - Discoloration - Mottled.
GENERALITIES – Cyanosis.
(3) Local, mental and general symptoms, which emerged or suffered
Case 3: Sepsis – Neurological Focus modification with the acute disease:
T.M.D.M female; 6 years, weight 20 kg. GENERALITIES – Pulse - weak.
FACE - Dryness - lips.
Summary of clinical medical history: Referred from an- (4) Symptoms or causalities that broke out the acute disease
other service to the Hospital Amico – Accident and Emer- (biopathographical symptons):
gency Department (Vila Mariana Unit), with frontal EAR - Inflammation - inside.
headache, fever (39 C) and many episodes of vomiting in
the first day; diarrhea denied. Admitted on 02/06/99 at 15h00.
Physical examination: active, hydrated, no fever; oto-
Repertorization7:
scopy showed hyperemia to the right, bright tympanic
membranes; oropharynx had intense hyperemia with no pu- 1. FEVER - Cerebrospinal fever.
rulent points. 2. GENERALITIES – Septicemia, blood poisoning.
Central Nervous System: conscious, oriented, without 3. HEAD - Congestion, hyperemia.
meningeal signs. 4. SKIN - Discoloration – Mottled.
Respiratory System: eupneic, non-cyanotic, normal pul- 5. GENERALITIES – Cyanosis.
monary auscultation. 6. GENERALITIES – Pulse – weak.
Cardio-circulatory System: rhythmic pulse; normal heart 7. FACE - Dryness - of lipss.
frequency. 8. EAR - Inflammation – inside.

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oriented, cooperative and calm; asked for full glass of
Homeopathic Symptoms Total Symptoms water; single episode of diarrhea.
Medicines covered weight
1 2 3 4 5 6 7 8
After 36 h (14/06/99 at 10.00):
Verat-v 8/8 17 3 2 1 2 3 2 3 1 Extubated, no vasso-active drugs. Slight episode of bron-
Lach 7/8 19 3 3 3 3 3 2 2 chospasm; 4 episodes of diarrhea.
Carb-v 7/8 16 3 3 2 3 3 1 1
Rhus-t 7/8 15 2 2 2 2 2 3 2
Bell 7/8 15 3 1 3 2 1 2 3 After 60 h (15/06/99 at 10.00):
Ars-a 7/8 14 1 3 2 1 2 3 2 Discharged from ICU: blood and urine culture negative.
Lyc 7/8 13 1 2 3 1 1 2 3 Discharged from hospital on 21/06/99:
Phos 7/8 13 2 2 3 1 2 2 1
Bry 7/8 12 1 2 3 1 1 3 1 After completing antibiotic treatment, clinically well,
Acon 7/8 11 1 2 2 1 1 2 2 discolouration of the skin at sites of haemorrhages.
Continued follow-up: with private doctor (allopathic pe-
Homeopathic treatment: Veratrum viride 30 cH, single diatrician), in good condition, no recurrence. Parents re-
dose of 5 drops. quested referral to a homeopathic physician.
Conventional treatment continued.
Evaluation by ICU team: Septic shock for Meningococ-
After 1 h (12/06/99 at 23.00): cemia reverted after 24 h of treatment, haemodynamic, re-
Temp. 37 C; skin coloration improved; HR 142 bpm; in- spiratory and renal parameters rapidly normalized. Once
crease of diuresis. more, polyuria was observed even after normalization of
Homeopathic treatment: repeated single dose of Vera- creatinine, with no other causes. Many episodes of diarrhea
trum viride 30 cH. observed but without clinical repercussions.
After 2 h (12/06/99 at 24.00):
Temp. 37.6 C; skin normal; increased perfusion; easily
palpable pulses; HR 170 bpm; diuresis in 2 h = 1,000 ml,
Discussion
clear; Dopamine continued in the same dose. Despite conventional therapy, invasive procedures and
Homeopathic treatment: none, observe. severe illness of patients SIRS in ICU, it was possible to se-
lect individualized homeopathic medicines. Conventional
After 4 h (13/06/99 at 02.00): treatments and procedures were never interrupted according
Temp. 37.8 C; skin normal; increased perfusion; full to commitments made to the Ethics Committee of the
pulses; HR 130 bpm; diuresis = 200 ml/h; hypotension after Amico Hospital. It was not possible to observe the diversity
attempting to decrease dopamine. of symptomatic changes (homeopathic aggravations, dis-
Homeopathic treatment: repeated single dose of Vera- charges, new symptoms, return of previous symptoms
trum viride 30 cH. etc.) after homeopathic medication and to evaluate the effi-
After 6 h (13/06/99 at 04.00): ciency of the medicine chosen,15 to ratify or rectify thera-
Temp. 37 C; skin normal; perfusion still improving; peutic action.
normal pulses; HR 125 bpm; diuresis = 300 ml/h; The results of homeopathic treatment was evaluated by
BP = 100  60 mmHg; face with normal color, rose colored using objective parameters of evaluation of homeopathic
lips. therapy (function of vital organs, need for therapy, patho-
Homeopathic treatment: none, observe. logical tests etc.) The efficacy of correctly chosen homeo-
pathic medicines was signaled by rapid reestablishment of
After 8 h (13/06/99 at 06.00): the normal function of vital organs.
Temp. 37 C; skin normal, pulses and perfusion; HR The 30cH potency was preferred and seemed to give a sat-
133 bpm; diuresis = 400 ml/h; BP = 100  55 mmHg; isfactory response without undesirable effects. Repetition
Dopamine and Fentanyl decreased. of homeopathic medicine doses follow classic homeopathic
criteria (cessation of improvement, return of guide-symp-
After 10 h (13/06/99 at 08.00): toms, or worsening of symptoms).
Temp. 37.2 C; skin normal, normal pulses and perfusion; After administration of individualized homeopathic med-
HR 123 bpm; diuresis = 140 ml/h; BP = 94  47 mmHg icine, normalization of cardiac rate was often observed,
with dopamine dose maintained; FiO2 decreased gradually concomitant with increase of diuresis and reestablishment
to 21% with saturation maintained at 98%. of the renal function as proven by the laboratory parameters
Homeopathic treatment: repeat single dose of Veratrum (plasma urea and creatinine) and reestablishment of normal
viride 30 cH. ventilation dynamics shown by diminished need for venti-
After 20 h (13/06/99 at 18.00): lation and increased oxygen saturation with normalization
Stable. of respiratory rate and of partial oxygen and carbon dioxide
pressures.
After 32 h (14/06/99 at 06.00): Frass et al conducted a randomized, double-blind, pla-
Temp. 37 C; HR 99 bpm; BP = 130  80 mmHg; nor- cebo-controlled trial in ICU to evaluate how homeopathy
mal respiratory parameters; diuresis = 150 ml/h; conscious, influences the long-term outcome in these patients, using

Homeopathy
 Homeopathic practice in ICU
MZ Teixeira et al
213
objective and pathognomic symptoms for the choice of ho- e perspectivas brasileiras. [The teaching of non-conventional prac-
meopathic medicines. Results showed that after 180 days, tices regarding health care in medical schools: world scenario and
there was a statistically significant higher survival with ve- Brazilian perspectives]. Rev Bras Educ Med 2004; 28(1): 51–60.
Available from: <http://www.educacaomedica.org.br/UserFiles/File/
rum homeopathy. The authors mentioned in discussion con-
2004/volume28_1/ensinos_de_praticas.pdf>.
straint to wider application of this method is the limited 2 Teixeira MZ, Lin CA, Martins MA. Homeopathy and acupuncture
number of trained homeopaths.16 teaching at university of Sao Paulo medical school: the undergradu-
A collection of clinical evidence about homeopathic treat- ates’ attitudes. Sao Paulo Med J 2005; 123(2): 77–82. Available
ment of patients in critical condition in ICU has recently from: <http://www.scielo.br/pdf/spmj/v123n2/a09v1232.pdf>.
been published in Additive Homöopathie in der Notfall- 3 Teixeira MZ. Homeopatia: desinformação e preconceito no ensino
und Intensivmedizin, offering to homeopathic physicians médico. [Homeopathy: lack of information and prejudice in medical
teaching]. Rev Bras Educ Med 2007; 31(1): 15–20. Available from:
more technical and scientific support for this type of practice
<http://www.scielo.br/pdf/rbem/v31n1/03.pdf>.
in several areas of emergency and medicine: including infec- 4 Teixeira MZ. Homeopatia: prática médica coadjuvante. [Homeopa-
tious diseases; hemostatic disturbances; cardiovascular, thy: codjutant medical practice]. Rev Assoc Med Bras 2007; 53(4):
lung, kidney and gastrointestinal illnesses; intra and postop- 374–376. Available from: <http://www.scielo.br/pdf/ramb/v53n4/
erative syndromes; toxicology; traumatology etc.17 27.pdf>.
Homeopathic training should include, beside the theoret- 5 Teixeira MZ. Semiologia homeopática em casos clı́nicos agudos
ical study experience of treatment of acute illness. graves. [Homeopathic semiology in serious acute clinical cases].
Homeopatia Brasileira 2001; 7(2): 33–54.
6 Hahnemann S. Organon of Medicine. William Boericke, Trans. 6th
Conclusion edn. New Delhi: B. Jain Publishers Pvt. Ltd., 1991. reprint edition.
7 Ribeiro Filho A. Repertorium Homeopathicum Digital II (Electronic
Various aspects need to be studied, clarified and im- Edition). Sao Paulo: Organon, 1998.
proved in the proposed approach to homeopathic treatment 8 Teixeira MZ. Homeopatia: ciência, filosofia e arte de curar. São
of acutely critically ill patients. These include improvement Paulo: Marcus Zulian Teixeira 2008. Available from: <http://www.
in methods for choice of homeopathic medicine, control of homeozulian.med.br/art_pdf/protocol_ohse_mzulian_english.pdf>.
variables that could facilitate prognostic evaluation of the 9 Kent JT. Lectures on homeopathic philosofy. North Atlantic Books
response, improvement of the methods for substantiating 1979.
results. Absence of a control group complicated quantita- 10 Kent JT. Lesser writings. In: New remedies: clinical cases lesser
writings aphorims and precepts. 2 edn. New Delhi: B. Jain Plublish-
tive evaluation of results. Evaluation was based on the opin- ers Pvt. Ltd., 1989, p. 239–252 [Chapter 2].
ion of the team of physicians in charge of the ICU. 11 Kent JT. Lesser writings. In: New remedies: clinical cases lesser
Our experience of patients with SIRS receiving homeo- writings aphorims and precepts. 2 edn. New Delhi: B. Jain Plublish-
pathic treatment leads us to conclude that it can be used ers Pvt. Ltd, 1989, p. 277–282 [Chapter 2].
for critically ill patients in conditions unsuitable for classic 12 Araújo C. Como tratar o paciente portador de doença aguda e grave.
homeopathic anamnesis, improving prognosis by triggering [How to treat the patient bearer of acute and serious disease]. In:
the vital response. Congresso Baiano de Homeopatia. Salvador: Anais, 1993.
13 Eisayaga FX. Tratado de Medicina Homeopática. [Treatise on Homeo-
Further improve systematization of the semiotic, thera- pathic Medicine]. 3rd edn. Buenos Aires: Ediciones Marecel, 1992.
peutic and prognostic approaches to these cases will lead 14 Leal SM. A prática homeopática na unidade de terapia intensiva
to increasingly good results. However, our initial results (UTI). [Homeopathic practice in the intensive care unit (ICU)].
show potential support of homeopathic medicines in the re- Rev Homeopatia (Sao Paulo) 2000; 65(1): 29–55.
covery of patients in critical condition in ICU. 15 Teixeira MZ. Agravação e prognóstico em homeopatia: uma siste-
The practice of homeopathy may effectively be extended matização de conceitos. [Aggravation and prognosis in homeopathy:
beyond treating chronic cases toward the less familiar but a systematization of concepts]. Rev Homeopatia (Sao Paulo) 1997;
62(1-2): 27–68.
highly important frontiers on the verge of life and death. 16 Frass M, Linkesch M, Banyais S, et al. Adjunctive homeopathic
treatment in patients with severe sepsis: a randomized, double-blind,
References placebo-controlled trial in an intensive care unit. Homeopathy 2005;
94(4): 75–80.
17 Frass M, Bündner M. Homöopathie in der Intensiv- und Notfallme-
1 Teixeira MZ, Lin CA, Martins MA. O ensino de práticas não-con-
dizin. München: Elsevier (Urban & Fischer), 2007.
vencionais em saúde nas faculdades de medicina: panorama mundial

Homeopathy