TO UNDERSTANDING THE INDICATION OF SILICEA REMEDY IN THE

MANAGEMENT OF OSTEOARTHRITIS KNEE

ASSIGNMENT SUBMITTED BY

BARVALIYA RUCHIKA HARESHBHAI

OF

SMT.MALINI KISHORE SANGHVI HOMOEOPATHIC MEDICAL COLLEGE,

MIYAGAM KARJAN

TO

THE GUJARAT UNIVERSITY

IN PARTIAL FULLFILLMENT OF THE REGULATION FOR THE AWARD OF THE

DEGREES

BACHELOR OF HOMOEOPATHIC MEDICINE & SURGERY

UNDER THE VALUABLE GUIDANCE OF GUIDE

DR.BHARAT PANCHAL M.D. (HOM)

DEPARTMENT OF ORTHOPADIC

YEAR 2018 - 2019

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 SMT.MALINI KISHORE SANGHVI HOMOEOPATHIC MEDICAL
COLLEGE

CERTIFICATE
This is to certify that

MISS.RUCHIKA H. BARVALIYA
As an intern, with

Provisional Registration No.

18235
Has satisfactorily completed her assignment

On topic

TO UNDERSTANDING THE INDICATION OF SILICEA REMEDY

IN THE MANAGEMENT OF OSTEOARTHRITIS KNEE

During internship period from

3nd May 2018 – 2rd May2019

PRINCIPAL SEAL OF COLLEGE HEAD OF DEPARTMENT

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 ACKNOWLEDGEMENT

First of all I express my sincere gratitude to founder of homoeopathy DR.SAMULE

HAHNEMANN who has made our existence on earth. I special thanks to Homoeopathy and
my collage give me this opportunity.

I take this opportunity to thank my guide DR. BHARAT PANCHAL (M.D.HOM) for his expert
guidance, valuable suggestions and kind support during this period of study.

I also thank full to DR.AMI MAJMUNDAR for their cooperation and all pt who allowed me to
study them.

I grateful to my principal DR.HITESH PUROHIT (M.D.HOM), Smt. M. K. Sanghvi

homoeopathic medical collage for extending his support in completion of my work

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INDEX:
SR.NO. DEFINE NO TITLE PAGE NO
1. NEED OF THE STUDY 5
2. AIM & OBJECTIVE 6
3. REVIEW OF LITERATURE 7
4. DESIGN OF STUDY 22
5. D – 10010 Case 1: SJR 23
6. D – 11216 Case 2: PHI 30
7. D – 6698 Case 3: PAY 36
8. D – 4214 Case 4: HKB 44
9. D – 10280 Case 5: PGI 55
10. D – 11211 Case 6: MAM 60
11. D – 7075 Case 7: SSR 65
12. D – 10119 Case 8: RAM 72
13. D – 7051 Case 9: SRP 78
14. D – 10091 Case 10: PPG 86
15. FINAL CONCLUSION 93
16. SUMMARY 94
17. BIBLIOGRAPHY 95
18. MASTER TABLE 96

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 NEED OF THE STUDY
In INDIA impact, nearly 80% of population shows OA among the patient who claimed for
knee pain, out of which approximately 20% reported incapability in daily activities and
around 11% need peculiar are. Approximately 40% population of more than 70 years shows
OA, in which nearly 2% have severe knee pain and disability.

In day to day practice I received patient who are diagnosed as osteoarthritis with other
many orthopedic problem in many times like rheumatic arthritis, myalgia, different type of
osteoarthritis, gout, lumbar spondylosis, cervical spondylosis, etc.

Increment in age exponentially increases the allied risk of OA, due to progressive changes in
routine diet, working milieu conditions and lifestyle patterns.

During my internship period, I saw many cases related to osteoarthritis knee which patient
get better in homoeopathy. So, I decided to take Osteoarthritis knee in my internship
assignment. In homeopathy many remedy gives great result in OA knee but some best
remedy among them is silicea. So I decided to improve my knowledge and explore its effect
in deeper level by doing this assignment.

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 AIM:
 UNDERSTANDING THE INDICATION OF SILICEA IN THE MANAGEMENT OSTEOARTHRITIS
KNEE

OBJECTIVE:
 To Study Introduction of Osteoarthritis.
 To Study clinical presentation of Osteoarthritis.
 To study the susceptibility of individual.
 To arrive at the prescribing Totality.
 To formulate the Posology & Planning & Programming.
 Study of silicea and apply as a management in OA knee.

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 REVIEW OF LITERATURE:

OSTEOARTHRITIS KNEE
OSTEOARTHRITIS:
OA is derived from the Greek word part osteo = meaning “of the bone”, combined with
arthritis: arthr = meaning “joint”, and itis = meaning of which has come to be associated
with inflammation.
Also known as Osteoarthrosis.
DEFINITION: OA is a degenerative joint disease. It is the most common form of chronic
disorder of synovial disorder of synovial joint characterized by focal loss of cartilage with
evidence of accompanying periarticular bone response in the form of subchondral bone
sclerosis and attempted new bone formation in the form of bony overgrowth called
osteophyte.

ANATOMY AND PHYSIOLOGY OF KNEE JOINT:

 ANATOMY OF KNEE JOINT:

The knee joint is the largest and most complex joint of the body. It is a hinge joint that
consists of three joints within a single synovial cavity:

 Laterally is a tibiofemoral joint, between the lateral condyle of the femur, lateral meniscus,
and lateral condyle of the tibia, which is weight-bearing.

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 Medially is a second tibiofemoral joint, between the medial condyle of the femur, medial
meniscus, and medial condyle of the tibia.

 An intermediate patellofemoral joint is between the patella and the patellar surface of the
femur.

The knee joint is made up of four bones. It is condylar synovial joint, incorporating two
condylar joints between the condyles of the femur and tibia, and one saddle joint between
the femur and the patella. It is also a complex joint as the cavity is divided by the menisci.
The femur or thighbone is the bone connecting the hip to the knee. The tibia or shinbone
connects the knee to the ankle. The patella (knee cap) as the small bone in front of the knee
and rides on the knee joint as the knee bends. The fibula is the shorter and thinner bone
running parallel to the tibia on its outside. The joint acts like hinge but with some rotation.
The knee is of synovial joint, which means it is lined by synovium. The synovium produces
fluid lubricating and nourishing the inside of joint. The articular cartilage is the smooth
surfaces at the end of the femur and tibia. It is the damage to this surface which causes
arthritis.

Ligaments of the knee joint:

The knee joint is supported by the following ligaments:

 Articular (fibrous) capsule: The Articular capsule is very thin, and is deficient anteriorly,
where it is replaced by the quadriceps femoris, the patella and the ligamentum patellae.

 Medial and lateral patellar retinacula: fused tendons of insertion of the quadriceps femoris
muscle and the fascia lata (deep fascia of thigh) that strengthen the anterior surface of the
joint.
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 Patellar ligament: Continuation of the common tendon of insertion of the quadriceps
femoris muscle that extends from the patella to the tibial tuberosity. This ligament also
strengthens the anterior surface of the joint.

 Oblique popliteal ligament: Broad flat ligament that extends from the intercondylar fossa of
the femur to the head of the tibia and lateral condyle of the femur to the medial condyle of
the tibia. The ligament and tendon strengthen the posterior surface of the joint.

 Arcuate popliteal ligament: Extends from the lateral condyle of the femur to the styloid
process of the head of the fibula. It strengthen the lower lateral part of the posterior surface
of the joint.

 Tibial collateral or medial ligament: Broad, flat ligament on the medial surface of the joint
that extends from the medial condyle of the femur to the medial condyle of the tibia.
Tendons of the Sartorius, gracilis, and semitendinosus muscles, all of which strengthen the
medial aspect of the joint, cross the ligament.

 Fibular collateral or lateral ligament: Strong, cord like rounded ligament on the lateral
surface of the joint that extends from the lateral condyle of the femur to the lateral side of
the head of the fibula. It strengthens the lateral aspect of the joint. The ligament is covered
by the tendon of the biceps femoris muscle. The tendon of the popliteal muscle is deep to
the ligament.

 Intracapsular ligaments: Ligaments within the capsule that connect the tibia and femur. The
anterior and posterior cruciate ligaments are named based on their origins relative to the
intercondylar area of the tibia.

 Transverse ligament: It connects the anterior ends of the medial and lateral menisci.

 Anterior cruciate ligament (ACL): Extends posteriorly and laterally from a pointanterior to
the intercondylar area of the tibia to the posterior part of the medial surface of the lateral
condyle of the femur. The ACL limits hyperextension of the knee (which normally does not
occur at this joint) and prevents the anterior sliding of the tibia on the femur.
 Posterior cruciate ligament (PCL): Extends anteriorly and medially from a depression on the
posterior intercondylar area of the tibia and lateral meniscus to the anterior part of the
lateral surface of the medial condyle of the femur. The PCL prevents the posterior sliding of
the tibia (and anterior sliding of the femur) when the knee is flexed. This is very important
when walking down stairs or a steep incline.

Articular discs (menisci): two fibro cartilage discs between the tibial and femoral condyles
help compensate for the irregular shapes of the bones and circulate synovial fluid.
1. Medial meniscus: Semicircular piece of fibrocartilage (C shaped). Its anterior end is attached
to the anterior intercondylar fossa of the tibia, anterior to the anterior cruciate ligament. Its
posterior end attached to the posterior intercondylar fossa of the tibia between the
attachments of the posterior cruciate ligament and lateral meniscus.

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2. Lateral meniscus: nearly circular piece of fibrocartilage (incomplete O in shaped). Its
anterior end is attached anteriorly to the intercondylar eminence of the tibia, and laterally
and posteriorly to the anterior cruciate ligament. Its posterior end attached posteriorly to
the intercondylar eminence of the tibia, and anteriorly to the posterior end of the medial
meniscus. The anterior surface of the medial and lateral menisci is connected to each other
by the transverse ligament of knee and to the margins of the head of the tibia by the
coronary ligaments.

STRUCTURE OF SYNOVIAL JOINTS:

Synovial joints have certain characteristics that distinguish them from other joints. The
unique characteristics of a synovial joint are the presence of a space a synovial cavity
between the articulating bones. Because the synovial cavity allows a joint to be freely
movable, all synovial joints are classified functionally as freely movable.
The bone at a synovial joint is covered by a layer of hyaline cartilage called Articular
Cartilage. The cartilage covers the articulating surface of the bone with a smooth, slippery
surface but does not bind them together. Articular cartilage reduces friction between bones
in the joint during movement and helps to absorb shock.

ARTICULAR CAPSULE:
A sleeve like articular (joint) capsule surrounds a synovial joint, encloses the synovial cavity,
and unites the articulating bones. The articular capsule is composed of two layers, an outer
fibrous membrane and an inner synovial membrane. The fibrous membrane usually consists
of dense irregular connective tissue that attaches to the periosteum of the articulating
bones. In fact, the fibrous membrane is literally a thickened continuation of the periosteum
between the bones. The flexibility of the fibrous membrane permits considerable movement
at a joint, while its great tensile strength helps prevent the bones from dislocating. The
fibers of some fibrous membranes are arranged as parallel bundles of dense regular
connective tissue that are highly adapted for resisting strains. The strength of these fiber
bundles, called ligaments, is one of the principal mechanical factors that hold bones close
together in a synovial joint. The inner layer of the articular capsule, the synovial membrane,
is composed of areolar connective tissue with elastic fibers.

SYNOVIAL FLUID:
The synovial membrane secretes synovial fluid, a viscous, clear or pale yellow fluid named
for its similarity in appearance and consistency to uncooked egg white. Synovial fluid
consists of hyaluronic acid secreted by fibroblast like cells in the synovial membrane and
interstitial fluid filtrated from blood plasma. It forms a thin film over the surfaces within the
articular cartilage.
Its functions include reducing friction by lubricating the joint, absorbing shocks, and
supplying oxygen and nutrients to and removing CO2 and metabolic waste from
chondrocytes within articular cartilage. Synovial fluid also contains phagocytic cells that

10
 remove microbes and the debris that results from normal wear and tear in the joint. When a
synovial joint is immobile foe a time, the fluid becomes quite viscous (gel-like), but as joint
movement increases, the fluid become less viscous.

ACCESSORY LIGAMENTS AND ARTICULAR DISCS:

Many synovial joints also contain accessory ligaments called extracapsular ligaments and
intracapsular ligaments. Extra capsular ligaments lie outside the articular capsule. Examples
are the fibular tibial collateral ligaments of the knee joint. Intracapsular ligaments occur
within the articular capsule but are excluded from the synovial cavity by fold of the synovial
membrane. Examples are anterior and posterior cruciate ligaments of the knee joint.
Inside some synovial joints, such as the knee, pads of fibrocartilage lie between the articular
surfaces of the bones and are attached to the fibrous capsule. These pads are called
articular discs or menisci. The discs usually subdivided the synovial cavity into two spaces,
allowing separate movement occurs in each space.

BURSAE AND TENDON SHEATHS:

The various movements of the body create friction between moving parts. Saclike structures
called bursae are strategically situated to alleviate friction in some joints, such as the
shoulder and knee joints. Bursae are not strictly part of synovial joints, but they do resemble
joint capsules because their walls consist of connective tissue lined by a synovial membrane.
They are filled with a small amount of fluid that is similar to synovial fluid. Bursae can be
located between the skin and bones, tendons and bones, muscles and bones, or ligaments
and bones. The fluid-filled bursal sacs cushion the movement of these body parts against
one another.
Structures called tendon sheaths also reduce friction at joints. Tendon sheaths are tube like
bursae that wrap around certain tendons that experience considerable friction. This occurs
where tendons pass through synovial cavities, such as the tendon of the biceps brachii
muscle at the shoulder joint and ankle, where many tendons come together in a confined
space, and in the fingers and toes, where there is a great deal of movement

EPIDEMIOLOGY:
 According to WHO OA is a commonest Musculoskeletal problem
 Globally approximately 250 million people have osteoarthritis of the knee (3.6% of the
population)
 Common women than man
 Age= overage 45 yrs ( around 45 t0 65 age)
 Osteoarthritis is most common joint disorder in INDIA. Symptomatic knee OA occurs in 10%
men and 13% in women aged 60 years or older.
 The number of people affected with symptomatic OA is likely to increase due to the aging of
the population and the obesity epidemic.

RISK FACTOR:

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 Systemic risk factor: Age,
Gender/ hormonal status,
Genetics,
Congenital abnormalities,
Diet
 Local risk factor: Obesity,
Injury/surgery,
Occupation,
Physical activity/sports
 Mechanical factor: Position,
Overuse

ETIOLOGY:
 OA represent the common end stage of many heterogeneous condition
 It is designated as primary or idiopathic when it occur in absence of an overt cause
 In secondary OA is an obvious underlying factor such as trauma, crystal disposition disease,
metabolic & endocrine disorder.
 Chemical
 Inflammatory arthropathies
 Immune abnormalities

Two type of OA:

1. Primary OA :
It occurs in old age.
Mainly in the weight bearing joint
OA is considered to occur largely due to “wear and tear” Over time.
Primary OA is commoner than secondary OA.
Cause: minor trauma, heredity, obesity, aging lead to focal degenerative changes in the
articular cartilage of the joint.

2. Secondary OA: disposition disease metabolic and endocrine disorder.

If forms cluster leads to progressive of process causing loosening, flaking & fissuring of the
particular cartilage. Resulting breaking of pieces of cartilage exposing subchondral bone
Cause: 1. congenital maldevelopment of a joint.
2. Irregularity of the joint surfaces from previous trauma.
3. Previous disease producing a damaged articular surface.
4. Internal derangement of knee.
5. Malignment.
6. Fracture.
7. Infection.

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 Background risk

Risk factors Symptoms Radiographic changes

Age Knee pain Osteophyte
OA
Gender Brief morning stiffness Narrowing
BMI Subchondral sclerosis
Occupation Signs Subchondral cysts
Family history of OA Crepitus
History of knee injury Restricted movement
Bony enlargement
Mild Moderate Severe

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 SFFT: STUCURE FORM FUNCTION TIME

KNEE JOINT: CHONDROCYTE CARTILAGE

CAPSULE, SYNOVIUM, EXCESSIVE DEGENARATION

PERIOSTUM, LIGAMENT, AS COMPARED TO
SUBCHONDRAL BONE, MUSCLE, REGENERATION
LIGAMENT
RELEASE OF INTERLEUKINS

ST SUPPRESS PROTEOGLY CAN

SYNTHESIS

ACTIVATION OF PLASMIN

DESTRUCTION OF
CARTILAGE

OESTOPHYTES FORMATION

FO FN

PAIN++

SWELLING++ MOVEMENT ALTERD

STIFFNESS++ DECREASE SPACE OF BONE
HEAVINESS++

O/E: CREPITATION
OSTEOPHYTE NODULE


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 Pathology:
Injury to cartilage

Crack in cartilage

Cytokines Accumulation of Cytokines

Chondrocytes

Enzymes released

Synovial Inflammation Bone thickening

Matrix broken down

Blood vessel

More cartilage damage proliferation

Chondrocytes from

Unorganized cartilage

Osteophyte formation

PATHOGENESIS: -
• Normal hyaline cartilage consists of chondrocytes embedded in extra cellular matrix
compose of water, type 2 collagen & proteoglycan, the chondrocyte secretes numerous in
active matrix metalloproteinase (maps) that include stromalysin, collagenase gelatinase etc.
which can destroy the whole cartilage frame work.
• These are activated by plasmin & activated stromalysin chondrocytes also release tissue
plasminogen activator (tpa) that converts blood or chondrocyte drive plasminogen to active
plasmin
• This cascade is modulated by tissue inhibitor of MMPS & plasminogen activation inhibitor
(PAI)

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• Interlukin1 plays a pivotal role in pathogenesis .it increase the synthesis & secretion of latent
or inactive MMPS & TPA. Suppresses proteoglycan synthesis & hence the cartilage repair
decreased TIMP & PAI synthesis & may be involving proliferation of osteoblast like cells
leading to osteophyte formation.
• Matrix repair is stimulated by insulin like growth factor (IGF 1) fibroblast growth factor &
transforming growth factor B (TGF B) which increases proteoglycan synthesis.
• In early stages their matrix & cartilage degeneration on hand & chondrocyte replication with
enhance biosynthesis on the other hand.
• This leads to a state homeostasis known as compensated OA
• In which both repair & degeneration are balanced. After few years the reparative process is
exhausted resulting in progressive OA
• Previously OA was considering to be & inherently non inflammatory disorder.
• The cartilage is devoid of nerve ending hence the pain in OA believe to originated from the
capsule, synovial, periosteum, subchondral bone, ligament, muscles etc.

Clinical feature:
 Pain: Night pain.
 During on descending or ascending stairs
 Squatting for toilet
 Climbing in to auto rickshaws & Buses
 Locking or bucking of knee joint.
 Stiffness in joint.
 First awaking (morning stiffness)

Sign:
 Swelling.
 Crepitation on moving the joint.
 Irregular & enlargement looking joints due to formation of peripheral osteophytes.
 Synovial Effusion of rare & transient.
 Restricted movement.

INVESTIGATION:
 X ray: Joint space narrowing.
 Subchondral cysts
 Oesteophyte formation
 Deformity of joint
 Serological tests.
 Body weight & Body mass index.
 MRI : synovial fluid examination = mild leukocytosis(<2000/mm3)
 Joint aspiration: may be considered for swollen joints the exclude other causes such as
septic arthritis & gouts.

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 CT scan: useful in assessing the axial joint.

Treatment:
AIM: Minimizing pain, reducing disability.
Four type of treatment: Self care, Medication, Physiotherapy and Surgery
1. Self care: Physical exercise.
Aerobic activity for 20 to 30 min
Weight loss
Menthol: oil made from mint & relive itching.
Ice packs: Reduce inflammation & dull sensation of pain.
2. Medication: Non steroid anti inflammatory drug.
Relive pain,
Decreased inflammation,
Decreased fever
Analgesic pain: relive pain.
Dietary supplement
Narcotic: relive pain, dull the sensation.
3. Physiotherapy: Hydrotherapy: using water to relive pain.
Ex: mineral baths & Hot tubs.
Stretching: Stretching exercise can improve flexibility & physical function.
Physical therapy: Restores muscles strength & function through exercise.

Acupuncture: Insertion of needles in to specific points on the body to

Relive pain & treat the conditions.
TENS (Transcutaneous electrical nerve stimulation): relive pain.
4. Surgery: Arthroscopy.
Joint replacement: Removing a damaged or defective joint & inserting a
New, functioning one in its place
Osteotomy: Repositioning of bone.

 HOMOEOPATHIC MANAGEMENT IN OSTEOARTHRITIS KNEE.

 Homoeopathic treatment aims to cure the sickness of the patient by stimulating the vital
dynamism or the power resistance of sick person. But if the power of resistance is
weakened by Degeneration of the cartilage results into osteoarthritis knee, due to which
it causes rubbing of bones and reduction of joint movement.
 DR. HAHNEMANN has advised to Constitutional remedy and cure Osteoarthritis knee so
that no hindrance may come in the way of cure. Homoeopathic treatment can help to
improve the general health of the person with Osteoarthritis.
 In the light of Hahnemann principles, the Homoeopathic remedies may be divided into
three varieties:

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 • Role of Constitutional Remedies
• Role of acute remedies
• Role of Miasmatic Remedies
Dr Hahnemann gives a fair idea on the importance of the constitution in Aphorism 5 (page
no-116) of organon of medicine.

“Useful to the Physician in assisting him to cure are the particulars of the most significant
points in the whole history of chronic disease to enable him to discover the fundamental
cause, which is generally due to a chronic miasm. In this investigations, the ascertainable
physical constitution of the patient.”(when the disease is chronic)his moral and intellectual
character, his occupation, mode of living & habit, his social & domestic relations, his age,
sexual function.). Constitution as natural condition of the body or mind disposition

No knowledge is perfect unless it includes an understanding of the origin, that is, the
beginning; and as all man’s diseases originate in his constitution it is necessary that his
constitution should be known if we wish to know his disease = BY PARACELSUS

 CONCEPT OF CONSTITUTION
 While establishing similarity, whether in an acute illness or in a chronic one, the
homoeopathic physician takes into account the highly characteristic features which are
based on constitutional peculiarities of the patient.
 The diagnostic features are more dependent on the environmental causative factors and
take some time to develop.
 Constitutional consideration is an important process for clinical diagnosis & treatment
and it also lays the foundation for health promotion & disease prevention.
 This readily explains how a single remedy could possibly cover a large number of clinical
states and how a single clinical state can claim its correspondence with a large number
of drug pictures.
 A well selected constitutional remedy of a patient gives the prescriber an insight into
some of the predispositions and cryptic manifestations of the disease.
 The homoeopathic physician is thus in an advantageous position with regard to (i) the
detection of constitutional tendencies even in the pre clinical stage, (ii) clinical diagnosis
in the prodromal stage and (iii) management, curative as well as preventive.

 FACTORS RELATED TO CONSTITUTION

1. Physical make up of the body.
2. Temperament
3. Desire, Aversion & intolerable to food
4. Heat and cold relation
5. Miasm
6. Diathesis
7. Susceptibility and response

18
 8. Addictions, Habits etc.
 It also include all other factors that in work in his framing and that make him distinct, define
& different and thus separates from other persons.

CONSTITUTIONAL MEDICINE:
Constitutional medicine means the medicine which can correct the constitutional defect
Concern for something apathetic in acquired. Every anti miasmatic medicine is constitutional
medicine. It acts better only other miasmatic effects are removed or brought to latent sate.

 ROLE OF CONSTITUTIONAL REMEDIES

 DEFFINITION: A therapeutic agent in the homoeopathic formulary that is chosen based on a
person’s individual constitutional type, taking into account the person’s symptoms,
personality, genetic, and familiar characteristic in some cases acute & chronic remedy may
also be constitutional remedy.
 Hahnemann who published his work on Chronic diseases and its cure advises to give more
importance to the patients past and family history to understand the genesis of illness and
to prescribe constitutional medication.
 Constitutional remedies act deeper into the system and correct the inherent disorder of the
individual. Thus the constitutional remedy not only cures the disease, but improves
individual’s health in general.
 In the modern terminology this could be said as the genetic preponderance or modification
due to the patient’s life style or circumstances or due to suppression of illness in the past.
 In homoeopathy, the choice of remedy is based on a consideration of the totality of an
individual’s symptoms and circumstances, including personality, behaviours, fears,
responses to the physical environmental, food preferences and so on.
 Constitutional remedy gradually decreases the intensity, frequency, and duration of acute
exacerbation in chronic disease.

SILICEA
INTODUCTION:
SILICON is a non metallic element in group 14 of the periodic table.
It is the second element of the group, carbon being the lightest and germanium, tin and lead
being heavier.
It is the second most abundant element in earth, after oxygen.
It is a great polychrest and has got powerful hold on the human economy.
SILICEA is a long and deep acting constitutional remedy which was proved and incorporated
in homoeopathic material medica by Hahnemann.

SILICA: silica, or silicon dioxide, occurs in nature as agate, amethyst, chalcedony, cristobalite,
flint, opal, quartz, sand and tridymite.

19
 It consist of colourless or white vitreous crystals, or of amorphous powder.

Synonym: SILICON DIOXIDE.

TERRA SILICEA
SILEX
Constitution: Lean, Thin body, sickly appearance & dry skin.
Weak & lax musculature with pale face
Extremely chilly patient
Sphere of Action: Mucous Membrane,
Skin,
Cartilage,
Elastic & Cellular Tissues,
Bones,
Nerves
Modality:
<: Cold air,
Draft,
Damp,
Uncovering,
Moon,
Pressure,
Weather changes
>: Warmth,
Summer,
Profuse urination,
Wet humid weather
Ailments From: Exposure of draught of air,
Vaccination,
Suppressed of foot sweat

MENTAL SYMPTOMS:
 Indifferent.
 Confusion of mind, difficulty in fixing the attention.
 Mental labor is very difficult.
 Very irritable, low spirited, peevish mood
 Yielding, faint hearted, Anxious mood
 Restless, Fidgety, starts at least noise
 Lack of confidence
 Lack of courage
 Weakness of will
 Lack of self esteem

20
 Do not believe they would achieve anything.
 Doubtful about own capacity.
 Feel incompetent.
 Taking responsibility
 Fear of failure, Fear of identity
 Memory weak, loss of memory, forgetfulness.
 Great depression and Irritability.
 Avoid taking a stand; do not face situations, irresolution, lack of commitment
 Oversensitivity, feel exposed, fear of exposure, fear of exposing myself, easily hurt
 Rigidity.

PHYSICAL GENERAL:
 Periodicity: pain from darkness to day & night.
 Pain increase and decrease gradually shifting and require frequent change of position.
 Sweat: hands, toes, feet, axillae
 Very offensive, intolerable, sour
 Carrion like odor from feet, with perspiration
 Sensitiveness: very sensitive to all impression, especially noise & becomes anxious.
 Desire: Cold drinks, ice cream.
 Wants to be magnetized.

Knee joint :
 Weakness of knee.
 Knee is painful as if too tightly bound = stiffness
 Tearing in keeps, while sitting, disappearing on motion.
 Weakness of legs particularly on descending steps, trembling of knees
 Violent stinging or laminating pain in knees
 Enlarged bursa over patella
 Sensation as if legs could not bear weight of body
 Painful stiffness of the knee, when walking & standing
 Inflammation of fibrous portions of joints, particularly knee.

DESIGN OF STUDY
A) INCLUSION & EXCLUSIVE CRITERIA OF STUDY

Inclusion Criteria of Study

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 I take a case which patient having Osteoarthritis knee.
 I take the case in which patient case was define & can get both physical & mental of patient
& also saw registration of action of medicine

Exclusive criteria of Study

 I exclude the case in which patient not come to follow up after one dose of silicea remedy in
which I cannot get action our medicine
 I exclude the cases in which cannot found a detail of patient in a manner of physical as well
as mental symptoms of patient so I cannot evaluate the patient

B) METHOD OF COLLECTION OF CASES

 I collect the cases in which I saw the follow up of cases or observe the case definition or
discuss with my guide about old cases in which patient get the action of silicea remedy from
that I can study the action of Homoeopathic medicine in the cases of Osteoarthritis knee.

C) METHOD OF STUDY
 I study the sign & symptoms of patient that must be match with Osteoarthritis knee sign &
symptoms.
 After that did examination of patient of osteoarthritis knee.
INSPECTATION: Swelling, effusion, erythema, ecchymosis
Knee Angle (Genu varum, Genu valgum)
PALPATION: Palpate the patient sitting position.
Medial and lateral femoral and tibial condyles
 Then I took the physical general of patient.
 Then I study mental symptoms of patient.
 From the both of these physical & mental symptoms of patient I will derive homoeopathic
medicine.
 After giving medicine I prepare criteria of symptoms to understand the action of silicea
medicine. I can conclude the level of cure in patient.
 At last I study the follow up of patient & come on conclusion of medicine action in
homoeopathy

CASE NO: 01 PHYSICIAN: Dr. Ami

D.O.C.: 21/9/’17 DEFINED NO: D: 10010
NAME: S.J.R AGE: 27 year SEX: Male
EDUCATION: 12th STD OCCUPATION: Job (worker)
STATUS: Married RELIGIOUS: Hindu
VEG/NON-VEG: both SIS: 2 BR: 2

22
ADDRESS: ANKLESHWAR

CHIEF COMPLAIN:
LOCATION SENSATION MODALITY CONCOMITTENTS
1.Mss Pricking Pain+3
Lower limb Stiffness++ <+2 walking APP- Normal
Knee joint Crepitation+2 <+2 Standing THIRST- Normal
Rt>Lt Difficulty+ in walking >+2 Rest URINE- Normal
O: - 2015 and standing STOOL- Normal
D: - Continuous

ASSOCIATED COMPLAINTS:
Location Sensation Modality Concomitant
GIT Acidity
ABDOMEN
Epigastrium
O: 2015
D: continuous

PHYSICAL GENERAL:
APPEARANCE: Medium built, Wheatish complexion
Perspiration: scanty – face+, Chest+ - Staining yellow
APPETITE: Normal THIRST: Normal
CRAVINGS: sweets+2, spicy+3, fish+2
AVERSION: --
STOOL: Normal URINE: Normal
Sleep: Normal DURATION: 6-hour POSITION: right side
Dreams: snake+, fight+ with others
Fear: high altitude+, ghost+
THERMAL: C3H2
WINTER SUMMER MONSOON
FAN 1 5 1
COVER Blanket Chadar Blanket
BATH Hot cold Tepid

PAST HISTORY: NIL

FAMILY HISTORY: NIL

PHYSICALEXAMINATION:
Weight: 64 kg Temp: A/F Pulse: 88/min Tongue: Pink Conjunctiva: Pink Nail: pink

23
 SYSTEMIC EXAMINATION:
Per abdomen: soft
RS: air-entry: BLE
CVS: S1, S2: normal
O/E: MSS: swelling & both knee crepitation

INVESTIGATION:
1) URINE ROUTINE: 2) BLOOD COUNT
Pus cell: 4-5 HB: 15.8 MCH: 28.3
Epithelial cell: 3 RBC count: 5.59 MCHC: 34.3
Uric acid: 3-1 PCV: 46.1 L: 36
MCV: 82.5 E: 2
Platelets: 16, 2000 M: 4
PROVISIONAL DIAGNOSIS
B/L Osteoarthritis knee

INVESTIGATION:
 X-ray: Both knee
Narrowing of medial space with tibial spiking is seen, S/O mild bilateral OA

LIFE SPACE:
CHILD HOOD: Patient was born in U.P in BHADVAR village. His family consists of mother,
father, Grandmother, uncle, aunty. Patient stays in joint family. Patient has 2 brothers and 2
sisters. Patient is elder son in his family. Patient father is farmer. He has angry by nature.
Sometime bit the patient when patient did something wrong that time patient has angry but
do not react in front of father. Mother is house wife. She is cool and calm by nature.
Patient‘s good IPR with his mother and father, brothers and sisters. Grandmother was cool
and calm by nature. In childhood financial condition was not good. Not fulfilled patient’s all
desire. Patient has also understood about financial condition of house. Patient said that
“MANE JE JARUR HOI TE HU MANGTO NAHTO. MANE KHABAR HATI KE FINANCIAL
CONDITION KHARAB 6E AETLE PAPA FULFILLED NAHI KARI SHAKE. ”
SCHOOL LIFE: Patient is studied till 12 th STD. patient studied in his own village. Patient is not
good in study. 1st to 5th &9th to 12th study in government school & 6th to 8th study in private
school. After school time, patient helped his mother and father in house hold work and also
in farming, because of poor financial condition. Patient has not interested in other school
activity. Patient has good IPR with all school teachers and friends.
EARLY LIFE: After passing of the 12 th std. patient do not go for higher study because his
financial condition is not good. Patient thinks he is an elder brother. So, he needs to take
responsibility of family. Patient thinks if he takes responsibility of family, it’s good for his
family & brother’s education. So, patient left study & come out Gujarat for job. Patient came
in VAPI and gets the job ‘SABERO’ company. Patient’s monthly salary was 4800. In 2009 to

24
 2011 he done job in VAPI. 2011 year his salary was 6000. In 2011, patient came in
ANKLESHWAR & get job in company. In ANKLESHWAR, patient’s monthly salary was 9432.
He save some money and deliver his home for his family.
MARRIAGE LIFE: Patient got marriage in 8 th December, 2016. His wife is good by nature and
she live with patient’s father and mother. Patient has good relation with his wife. Patient
thinks that “JOB U.P MA J HOI TO SARU THAT KEM KE TYA FAMILY SATHE REVA TO MALE.
AHIYA KARTA OCHHI SALARY HOI TO PAN CHALSE. PAN HAVE U.P MA J REVU 6E.” now
patient is at Baroda so, he feels so sad because of he is stay away from the family. Patient
wants to bring his wife with him in 2018. After 2-3 years he wants back his home because of
family issue. His brother has joint NAEVI. So, patient wants to take care of his father and
mother.
PATIENT AS A PERSON: patient is family oriented. He took all responsibility about his family.
Patient is helpful in nature. Patient is sentimental & sympathetic about family. Patient is
hard worker. He wants work neat & clean. Patient is angry by nature. Patient is an anxiety
about his family. Patient will take all decision own and good care about his mother & father.
Patient’s memory is weak in the study.

TOTALITY:
 Cool and calm++
 Anger +2 - suppressed sometime
 Anxiety about family
 Sentimental+2
 Sympathetic+2
 Fastidious+2
 Responsible+3
 Fear of ghost+, high place+
 Dreams of fights with others+, snakes
 Perspiration – scanty- face+, chest+ - stain yellow
 Cr: spicy+3, sweet+2, fish+2
 Chilly patient

REPERTORISATION:
 Mind – anger- suppressed
 Mind- anxiety- family about his
 Mind- fastidious
 Mind – sentimental
 Mind – sympathetic
 Mind - responsibility
 Mind – tranquility
 Mind – religious belief
 Mind – fear – ghost of

25
 Mind – fear – high place of
 Dreams – fights
 Dreams – snakes of
 Perspiration – scanty sweat
 Face – perspiration
 Chest – perspiration
 Perspiration – stain - yellow
 General- food & drink – fish - desire
 General- food & drink – sweets - desire
 General- food & drink- pungent - desire
 Chilly patient

REPERTORIAL RESULT:
LYCO: 25/15 ARS: 18/12
PHOS: 26/15 CAUT: 13/10
LACH: 19/14 NUX.V: 14/9
SILICEA: 18/13 NAT.M: 22/15

First prescription: RHUS TOX 200 2-2-2

ii 2-2-2/2 wks

REASON OF SELECTION OF MEDICINE: Anxiety about family

Fastidious
Hard worker
Taking responsibility seriously
Helping
Fear of high place
Perspiration on face
Chilly patient

PLANNING AND PROGRAMMING:

DEFINE WITH REASONS THE STATE POTENCY-CHOICE REPETITION
1.SUSCEPTIBILITY moderate 200 Infrequent
Age- 27 year
Sex- male
Occ. = Job
pace of disease- slow
disease
seat of disease: structural irreversible
2.SENSITIVITY(MIND& NERVES) 200 Infrequent
Mind ++, Nerves ++

26
 3. SUPPRESSIONS (IF ANY) No -- --
4. CORRESPONDANCE (DEGREE & LEVEL) CONST. Rx Infrequent
Mind++, Body+ SILICEA 200
5. CORRESPONDANCE (DEGREE & LEVEL) SECTOR Rx --
--
6. CORRESPONDANCE (DEGREE & LEVEL) INTER-CURRENT Rx --
--
7. FUNCTIONAL CHANGES 200 Infrequent
Present
8. STRUCTURAL CHANGES 200 Infrequent
Irreversible
9. VARIATIONS( WITH TIME) -- --
10. GENERAL VITALITY : Good High 1M Infrequent
11. PRESENTATION- Infrequent
A. FUNDAMENTAL MIASM 200
PSORA
B. DOMINANT MIASM 200 Infrequent
SYCOTIC
C.SECTOR(ACUTE/EXACERBATION) -- --
D. RECENT GROUP (STATE FROM-----) -- --
E. CONFUSED -- --

CRITERIA
1. Rt knee pain
2. Rt Stiffness
3. Lt Knee pain
4. Lt Stiffness
5. Difficulty in walking
6. Difficulty in standing
7. O/E: knee crepitation
Swelling
8. Weight.

FOLLOW UPS:
DATE 1 2 3 4 5 6 7 PRESCRIPATION
5/10/”17 >+ >+ >++ >++ >+ >+ Crepitation SILICEA 200 3p Hs, ii
S.Q 2×2×2/ 4 wks
Swelling ->+
Wt = 64kg

27
 2/11/’17 >+20% >+20% >+ >+ >+ >+ Crepitation SILICEA 200 3p Hs, ii
S.Q 2×2×2/ 4 wks
Swelling ->+
23/11/’17 >++50% >+ >++ >++ >++ >++ Crepitation SILICEA 200 3p Hs, ii
+50% 50 50 50 50 S.Q 2×2×2/ 5 wks
% % % % Swelling ->++
28/12/”17 >+ >+ >+ >++ >+ >+ Crepitation>+ SILICEA 200 3p Hs, ii
Swelling->+ 2×2×2/ 4 wks
25/1/’18 >++ >++ >++ >++ >+ >+ Crepitation>+ SILICEA 200 3p Hs, ii
Swelling->+ 2×2×2/ 4 wks
22/2/”18 >++ >++ >++ >++ >++ >++ Crepitation>+ SILICEA 200 3p Hs, ii
Swelling->+ 3×3×3/ 4 wks
22/3/”18 <+ >+ >++ >++ <+ <+ Crepitation>+ SILICEA 1M Hs wkly, ii
Swelling- 0 3pills TDS/ 4 wks
Wt= 66.5kg
20/4/”18 >++ >+ SQ >+ >+ >+ Swelling – 0 SILICEA 1M Hs wkly,
ii 3 pills TDS/ 4 wks
26/4/”18 >++ >+ >+ >+ >+ >+ Swelling – 0 SILICEA 1M Hs wkly,
ii 3 pills TDS/ 3 wks
7/6/”18 >+ >+ >+ >+ >+ >+ Swelling – 0 SILICEA 1M Hs wkly,
ii 3 pills TDS/ 4 wks
5/7/’18 <+ >+ >+ >+ >+ >+ Swelling - ++ BRYONIA 200 3 pills
A/F= Tenderness++ TDS , ii 3 pills TDS/ 1
kick of + wks
the
bike

CONCLUSION:
 In this case first prescription is RHUS TOX 200 patient feel better after that 1 st follow up
patient feel better in knee pain+, stiffness+ but no changes in crepitation.
 Physician prescribed SILICEA 200 3p HS (CR) then patient feel better.
 Susceptibility is moderate to high on the bases of age, sex, occupation.

28
 In 2st follow up patient feel 20% better in knee pain+, stiffness+, swelling+ but no changes in
crepitation
 In 3rd follow up patient feel 50% better in knee pain++, stiffness++, swelling++ in both knee
but no changes in crepitation
 After then better in knee pain+, stiffness+, knee crepitation+.
 After few follow ups complain become aggravated, so Physician gradually increases the
potency (1M). After that patient feel 30-40% better in knee Pain+, stiffness+, and
crepitation+, swelling++
 SILICEA was choosing as CR and also its effect on bony tissue so that it can help to pt to
improve bone strength.

CASE NO: 2. PHYSICIAN: DR.AMITA AGRAWAL

D.O.C.: 14/12/’18 DEFINED NO: D: 11216
NAME: P.H.I. AGE: 45 year. SEX: Female
EDUCATION: 7th pass OCCUPATION: house wife & sew work
STATUS: married RELIGIOUS: Muslim
VEG/NON-VEG:N.V. SIS: 4 BR: 3

29
SON: 1 DAUGHTER: 1
ADDRESS: AMOD

CHIEF COMPLAIN:
LOCATION SENSATION MODALITY CONCOMITTENTS
MSS
Extremities Pain+ <++ after standing
Knee joint Numbness+ >++ sitting
Onset : 2to 3 months No swelling No Cold/ hot water
D: 1to2 min

Ankle joint Pain+ <+butter milk

O: 6 to 7 months Swelling+ <+Sour food
>+hot water
APP - decrease
General Weight gain Thirst - Normal
O: 6 to 7 year (100 kg) Stool - Normal
Urine – Normal

ASSOCIATED COMPLAINTS:
Location Sensation Modality Concomitant
Skin Hyper pigmentation
On face both sides of No itching
cheeks No burning
O: 1 Year
F: on & off

C.V.S. <+8 A.M.

Nausea
O: 7 to 8 year >+anti hypertension
Discomfort

PHYSICAL GENERAL:
APPEARANCE: wheatish complexion, obese.
Perspiration: ++
APPETITE: Normal THIRST: Normal
CRAVINGS: Bitter++
AVERSION: NIL
STOOL: Normal URINE: Normal
Sleep: 6 to 7 hour. Position: Supine
Dreams: NIL
MENSTURAL FUNCTION:
F.M.P.: 16 year L.M.P.: 8 to 10 year

30
Menses: regular cycle: 28 days Duration: 7 days
THERMAL: C4H
WINTER SUMMER MONSOON
FAN 0 Full 0
COVER Thick Thick Thick
BATH Hot Tepid Hot

PAST HISTORY: Hystectomy (8 to 10 year ago)

K/C/O: HTN (6 to 7 years)
FAMILY HISTORY: Bro: MI

PHYSICAL EXAMINATION:
Weight: 96kg BP: 110/70mmhg Pulse: 70/ min Tongue: pink moist. Conjunctiva: pink

SYSTMIC EXAMINATION:
RS: Air-entry: BLE
Breath sound: vesicular
CVS: S1, S2: Normal

PROVISIONAL DIAGNOSIS:
OA knee
Hypermelenesis
K/C/O: HTN

INVESTIGATION: 25/1/’18
Creatinine: 0.92
Uric acid: 4.7
Blood sugar fasting: 111
R.A.: Non reactive

LIFE SPACE:
CHILDHOOD: Pt was born in BHARUCH. At that time there was live with her Mother, Father,
Brother, Sister. Pt has 2 elder & 1 younger brother and 4 sisters are in family. In which 1 st
elder bro. was died to MI attack and 1 younger bro. was died to shooter by gun in South
Africa before 10 & 12 years ago. Pt’s father was bus driver in Gujarat Depo (GSRTC). And Mo
was house wife. His financial condition was poor.
SCHOOL LIFE: Pt was studied in BHARUCH from 1st to 7th. She left study further because of
less interest in study. She has still regret of it. After that she started doing sewing in GIDC
with her elder sis. By doing this she was helping her family financially. She was “LADKI” of
that company because she was very younger in whole company and also due to her nature.

31
 At the age to around 13 to 14, pt’s father was died. After 6 to 7 years of that incidence, pt
got married. Pt’s all sisters married.
MARRIGE LIFE: Pt husband is 8 to 9 years older than pt. he is very supportive, calm by
nature. Pt’s FIL was died when pt’s husband was 1.5 year of age. Pt’s IPR with SIL and MIL
was good. Financial condition of family (in law’s family) was very average. Pt’s husband
doesn’t have mobile at that time (12 to 13 years). By some contact of some relative pt’s
husband was succeed in going Saudi. He is doing job of electrician there. Later contract of
3.5 years get increased due to his good work from last 12 year. He is living there and sends
some money for family.
Pt has 2 children. Elder son was also gone with her husband in Saudi for some work. After
12th pass, He is Complete his graduation in sigma and doing job of electrician in same collage.
In which he make good money. Younger daughter’s nature is good. She is married. Pt’s
husband comes home yearly for 1.5 months. Pt’s said” our financial condition is very poor,
although I starting hard work, Allah give us all and now, we are fortunate for whatever we
have”.
CURRENT LIFE: Pt is doing sewing work at home. Son is doing in job of electrician in where
he’s studying. Pt is living in AMOD with her son only.
PATIENT AS A PERSON: patient’s nature is cool & calm. She is very workaholic. She is very
emotional and sensitive, supportive, positive person. Pt believe in god (Allah) too much &
said “ALLAH JE KRE AE BHADHU SARU J KRE”. She is very kind too. She can give all food or
money to the person who needs that. Pt helps to beggars by giving food and other stuffs.

TOTALITY:
 Cool & Calm Nature
 Supportive Family
 Attach With Son
 Religious
 Sentiment
 Helpful
 Workaholic
 Craving Bitter Food
 Perspiration Whole Body
 Car motion sickness
 Chilly Patient

REPERTORISATION:
 Mind - Attached
 Mind - Helping Others
 Mind - Sentimental
 Mind - Religious Affections
 Mind - Support

32
 Mind - Tranquility
 Mind - Work-Desire
 Extremities - Pain – Knees – Sitting - Amelioration
 Extremities - Pain - Knees - Standing - Aggravation
 General - Food And Drinks - Bitter - Desire
 General - Motion- Aggravation
 Chilly Pt

REPERTORIAL RESULT:
SULPH: 10/5 N.V.: 7/4
LACH: 7/5 SILI: 5/3
ARS: 7/4 PHOS: 5/3
N.M.: 7/4 PULS: 5/4

REASON OF SELECTION OF REMEDY: Cool & Calm Nature

Religious
Supportive
Sentimental
Helping other
Extremities = <: standing
>: sitting

PLANNING AND PROGRAMMING:

DEFINE WITH REASONS THE STATE POTENCY-CHOICE REPETITION
1.SUSCEPTIBILITY low to moderate
Age- 45 year 0/1 to 30 Infrequent
Sex- Female
seat of disease-structural reversible
pace of disease- gradual
2. SENSITIVITY( MIND & NERVES)
Mind+, Nerves++ 0/1 Infrequent

3. SUPPRESSIONS (IF ANY) -- --

No
4. CORRESPONDANCE (DEGREE & LEVEL) CONST. Rx
Mental++, physical+ SILICEA Infrequent
5. CORRESPONDANCE (DEGREE & LEVEL) SECTOR Rx --
--
6. CORRESPONDANCE (DEGREE & LEVEL) INTER-CURRENT Rx --
--
7. FUNCTIONAL CHANGES

33
 Present 0/1 Infrequent
8. STRUCTURAL CHANGES
Irreversible 0/1 Infrequent
9. VARIATIONS( WITH TIME) -- --
10. GENERAL VITALITY
Good 0/1 Infrequent
11. PRESENTATION-
A. FUNDAMENTAL MIASM 0/1 Infrequent
SYCOTIC
B. DOMINANT MIASM
SYCOTIC 0/1 Infrequent
C. SECTOR (ACUTE/EXACERBATION) -- --
D. RECENT GROUP (STATE FROM-----) -- --
E. CONFUSED -- --

FIRST PRESCRIPTION: SILICEA 0/1 1P HS/wk

SL TDS /4Wks

CRITERIA:
1. Knee pain- Rt/Lt
2. Knee numbness
3. Ankle pain
4. Ankle swelling
5. Hyper pigmentation/Molex
6. O/E wt, BP

FOLLOW UPS:
DATE 1 2 3 4 5 6 PRESCRIPTION
4/1/’19 S.Q. S.Q. >+ >+ > Wt.97 kg SILICEA 0/2 1P HS/wks
BP:132/80mmHg SL TDS/4Wks
8/2/’19 S.Q. 0 S.Q. >++ S.Q. Wt.97 kg SILICEA 0/3 1P HS/wks
BP:136/90mmHg SL TDS/4Wks
5/4/’19 S.Q. <+ <+ >+ >+ Wt.98 kg SILICEA 0/4 1P HS/wks
BP:110/80mmHg SL TDS/4Wks

CONCLUSION:
 After case definition prescribe SILICEA as constitutional remedy on basis of patient mental &
physical characteristic.
 Susceptibility is low to moderate according to age, sex, seat of disease.
 In a first follow up pt complain not relieved in knee pain. So we prescribed increase potency.

34
 There is no reduction in weight so it may be take time for relief in joint pain even after
potency of remedy is increase.
 But patient feel better in ankle pain+, ankle swelling+.

CASE NO: 03. PHYSICIAN: DR.AMI

D.O.C.: 13/11/14 DEFINED NO: D: 6698
NAME: P.A.Y. AGE: 50 year. SEX: female
EDUCATION: 3rd STD. OCCUPATION: labour work
STATUS: Married RELIGION: Muslim
VEG/NON-VEG: All SIS: 2 BR: 4
DAUGHTER: 4. SON: 1

35
ADDRESS: IKHKHAR

CHIEF COMPLAIN:
LOCATION SENSATION MODALITY CONCOMITTENTS
1) MSS Pain ++ <+Morning
Lower Extremities Pricking Type <++Standing For Long
Both Knee Joint Time
Onset: 2 Year <++Excretion
Duration: ½ Hr >Hot Water Application
F: Daily < Sour, Curd, Butter Milk
RT>LT
2)Both shoulder
LT>RT Pain+
Lower back
3)chest Jerking type pain
LT>RT No difficulty in
D:15to20 min breathing
F:2 to 4 times/ day

ASSOCIATED COMPLAINTS:
Location Sensation Modality Concomitant
Respiratory system Cold A/F getting wet Thirst - increase
<morning
Throat Pain+ <swallowing
O: 1 week Burning A/F winter
Dry Cough <night

PHYSICAL GENERAL:
APPEARANCE: obese, dark complexion
OEDEMA: both feet< hanging leg down
PERSPIRATION: forehead
APPETITE: good THIRST: Normal
CRAVINGS: chicken+, Pungent++
AVERSION: Sour+, sweet+
STOOL: Normal URINE: Normal
Sleep: Normal
Dreams: occ. routine

MENSTURAL FUNCTION:
F.M.P.: 14 to 15 year L.M.P.: since 5 to 6 year
Menses: regular Cycle: monthly Duration: 6 days

36
Color: dark red Stains: brownish
THERMAL: C3H2
WINTER SUMMER MONSOON
FAN 2 Full 0
COVER Blanket Chadar Chadar
BATH Hot Hot Hot

PAST HISTORY: HTN

FAMILY HISTORY: NIL

PHYSICAL EXAMINATION:
Weight: Temp: AF Pulse: 73/min Tongue: pink Conjunctiva: pink
CVS: NAD BP: 150/90mmhg

SYSTMIC EXAMINATION:
Per abdomen: Soft
RS: Air entry: BLE
Breath sound: Vesicular

PROVISIONAL DIAGNOSIS:
B/L osteoarthritis knee

INVESTIGATION:
1) BLOOD: WBC: 10,900
HB: 13.40. N/L/E/M/B: 76/20/03/01/00
RBC count: 5 platelets: 287,000
PCV: 40.90 ESR: 22
MCV: 81.80
MCH: 26.80
MCHC: 32.76

LIFE SPACE:
A 50 year old lady come in OPD with complain of backache, knee pain, shoulder pain, having
wheatish complexion, fatty, short appearance.
CHILDHOOD: Patient’s childhood passed at MESRAD village. Her family consisted father,
mother, 4 brothers & 2 sisters. Among them all were dead except 1 younger bro. her father
was irritable by nature, he was short tempered, but pt never replied against him .Father was
teacher by profession. She is the eldest child of her family. Her 1st brother was M.R. & died
after her marriage. Her 2nd brother died at 5th & 6th yrs of age, 3rd sister died at 1.5 year of
age, 4th & 5th Brother& Sister also died. Her mother’s nature was cool & calm. She had good
IPR with her.

37
 After sickness of her father, her Mo started maid work and earn money. When ask about
death of brother & sister. Patient said “KHUDA NI MARJI, APNE SHU KRI SHAKVANA “.
Patient used to help mother’s responsibility. So, Pt worried about ‘BHADHU KEVI RITE
THASE’. All responsibility to taken by her mother. Uncle was never support them. Father
died due to illness. At that time patient feel “UPAR VALA PAR CHODYU, AENI JE MARAJI HOY
TE THAY”.
SCHOOL LIFE: Patient studied up to 3rdstd due to lack of interest & at that time she had
13to14 friends. After left study she want doing household work & look after of bro. & sis.
MARRIAGE LIFE: she got marriage at the age of 19th year. Her maternal Grandparents helped
them in marriage expense. At her in law’s family, MIL, FIL, Husband & 2 BIL&2SIL.her MIL
was cool & calm, but occ. Irritable on work matter, but pt never answer her back & said if
more back to answer then issues more create. Her FIL was cool & calm. Husband is good by
nature, occ. Conflicts occurs due to child matter, but pt replied him back occ. Good IPR with
BIL, she has no relation with her 2nd SIL. She has good IPR with society.
She has 1 son & 4 Daughters. Son is cool & calm by nature, studied up to S.S.C. & doing job
at deliver service since 1.5 year. Patient said due to poor financial condition, so they cannot
give him more education. If anyone help me for him education, I also give more education
him. Now, his salary is 5000/month. Her 3 elder daughters are good by nature, but 4 th
daughter is irritable.
Pt’s mother suicide due to bro’s harassment because he was MR. then pt worried about
younger bro, because he was younger & alone. So, Pt went at maternal home & then did
marriage of her bro. then came back to her home. At the time of mo’s death, patient cried
for 1 2 wks. There was no longer effect on her.
PATIENT AS A PERSON: pt has anxiety about money (dept). She is cool & calm by nature,
never speak against elder. She is Helpful by nature. She want to be company, didn’t like to
alone. Patient said “NASIBMA J DUKH LAKHELU HOI TO SHU KRVANU”. Believe in god (Allah).

TOTALITY:
 Anger: cool & calm
 Anxiety : about dept(money matter)
 Helping nature.
 Responsible.
 Religious.
 Want to be company.
 Perspiration: forehead.
 Cr.: chicken+, pungent++
 Av.: sour+, sweet+
 Dream: occ. Routine.
 Fear: animal, lightening.
 Chilly patient.

38
 REPERTORISATION:
 Mind - Tranquility
 Mind – anxiety - money matters, about
 Mind - benevolence
 Mind - religious affections
 Mind – company - desire for
 Mind – responsibility - taking responsibility too seriously
 Mind - helping others
 Mind – fear - animals
 Mind – fear - lightning
 Face – perspiration - forehead
 Dreams - events - daily
 Generals - food & drinks – chicken - desire
 Generals - food & drinks – pungent - desire
 Generals - food & drinks – sour - aversion
 Generals - food & drinks – sweet - aversion
 Chilly patient

REPERTORIAL RESULT:
PHOS: 14/9 SIL: 10/7
PULS: 10/9 LAC: 8/7
SULPH: 8/7 N.V.:6/5
SEP: 9/8 CAL. 8/6

REASON OF SELECTION OF REMEDY: Anxiety about Money Matter

Taking Responsibility Seriously
Helping
Fear - Lightning
Perspiration - on Forehead
Chilly Patient

PLANNING AND PROGRAMMING:

DEFINE WITH REASONS THE STATE POTENCY-CHOICE REPETITION
1.SUSCEPTIBILITY moderate to high
Age-50 yrs 200 Infrequent
Sex - female
Occ.- Labour work
Seat of disease- structure irreversible
Pace of disease-slow
2. SENSITIVITY( MIND & NERVES) 200 Infrequent
Mind +, Nerves++

39
 3. SUPPRESSIONS (IF ANY) -- --
No
4. CORRESPONDANCE (DEGREE & LEVEL) CONST. Rx Infrequent
Mental++, Physical++ SILICEA 200
5. CORRESPONDANCE (DEGREE & LEVEL) SECTOR Rx --
--
6. CORRESPONDANCE (DEGREE & LEVEL) INTER-CURRENT Rx
THUJA 1M Infrequent
7. FUNCTIONAL CHANGES 200 Infrequent
Present
8. STRUCTURAL CHANGES 200 Infrequent
Irreversible
9. VARIATIONS( WITH TIME) -- --
10. GENERAL VITALITY 200 Infrequent
Good
11. PRESENTATION-
A. FUNDAMENTAL MIASM 200 Infrequent
SYCOTIC
B. DOMINANT MIASM 200 Infrequent
SYCOTIC
C. SECTOR (ACUTE/EXACERBATION) -- --
D. RECENT GROUP (STATE FROM-----) -- --
E. CONFUSED -- --

FIRST PRSCRIPTION: SILICEA 200 3p HS/ 2weeks

SL pills TDS/ 2 wks

CRITERIA:
1. Knee Pain: Right
2. Knee Pain: Left
3. Both Shoulder: Pain
4. Back Pain
5. Chest Pain
6. O/E Crepitation
Weight
Bp

FOLLOW UPS:
DATE 1 2 3 4 5 6 PRESCRIPTION

27/11/’14 >+ >+ >+ S.Q. >+ B.P.140/80mmHg SILICEA 200 3p

40
 HS/WKLY
ii pills TDS/ 2 wks
11/12/’14 >+25% >+25% >+ >+ >+ THUJA 1M 1P HS
SILICEA 200 3p HS
Ii 4P HS
ii pills TDS/ 4 wks
22/1/’15 >++ >++ >+ >++ >++ THUJA 1M 1P HS
SILICEA 200 3p HS
Ii 4P HS
ii pills TDS/ 4 wks
19/2/’15 >++ >++ >++ >++ >++ THUJA 1M 1P HS
SILICEA 200 3p HS
Ii 4P HS
ii pills TDS/ 4 wks
9/4/’15 >++50% >++50% >+ >++ >+25% THUJA 1M 1P HS
SILICEA 200 3p HS
Ii 4P HS
ii pills TDS/ 4 wks
7/5/’15 >++ >++ >+ >++ >++ THUJA 1M 1P
HS/wkly
SILICEA 200 3p
HS/wkly
Ii 2x2x2/ 4 wks
18/6/’15 >++ >++ >++ >++ >++ THUJA 1M 1P
HS/wkly
SILICEA 200 3p
HS/wkly
Ii 2x2x2/ 4 wks
23/7/’15 >+ >+ >+ >+ >+ B.P.120/70mmHg THUJA 1M 1P
HS/wkly
SILICEA 200 3p
HS/wkly
Ii 2x2x2/ 4 wks
20/8/’15 >++ >++ >++ >+ >+ B.P.120/80mmHg THUJA 1M 1P
HS/wkly
SILICEA 200 3p
HS/wkly
Ii 2x2x2/ 4 wks
15/10/’15 >++ >++ >+ >+ >+ THUJA 1M 1P
HS/wkly
SILICEA 200 3p

41
 HS/wkly
Ii 2x2x2/ 4 wks
3/12/’15 >++ >++ >+ >++ >+ B.P.130/80mmHg SILICEA 1M 1P
Tingling & ii TAB 1x1x1/1st &
Numbness 3rd wks
ii pills Tab 1x1x1/2nd
& 4th wks
31/12/’15 >++ >++ >+ >+ >+ SILICEA 1M 1P/1st
wks SL 3 pills TDS
SL 1P HS/wkly
2nd, 3rd & 4th wks
18/2/’16 <+ <+ >+ >+ >+ O/E: NAD SILICEA 1M 3P
HS/Wkly
Ii Tab 1x1x1 /4 Wks
19/3/’16 >+ >+ <+ >+ >+ THUJA 1M 1P HS
SILICEA 200 3p HS
Ii 4P HS
Ii 3 pills / 4 wks
9/4/’16 >++ >++ >+ >+ >+ THUJA 1M 1P HS
SILICEA 200 3p HS
Ii 4P HS
Ii 3 pills / 4 wks
21/4/’16 >++ >++ >+ >+ >+ B.P.140/80mmHg SILICEA 1M 1P
HS/WKLY
Ii TAB 1x1x1/4wks
21/7/’16 >++ >++ >+ >+ >+ B.P.130/80mmHg THUJA 1M 1P HS
SILICEA 1M 1P HS
SL TDS/2 wks
17/11/’16 <+ <+ >+ B.P.120/90mmHg THUJA 1M 1P
HS/WKLY
SILICEA 1M 3p HS
ii pills TDS/ 4 wks
30/3/’17 >+ >+ >+ <+ >++ C/O increase so, THUJA 1M 1P
stop homo. Tx HS/WKLY
SILICEA 1M 3p HS
ii pills TDS/ 4 wks
11/5/’17 >++ >++ >+ >+ >++ B.P.140/90mmHg THUJA 1M 1P
Wt. 63kg. HS/WKLY
SILICEA 1M 3p HS
ii pills TDS/ 8 wks
26/10/’17 <+ <+ <+ <+ <+ B.P.120/80mmHg THUJA 1M 1P

42
 HS/WKLY
SILICEA 1M 3p HS
ii pills TDS/ 8 month

CONCLUSION:
 After case definition prescribe SILICEA as constitutional remedy on basis of patient mental &
physical characteristic.
 In this case first prescription SILICEA 200 3p HS (CR) patient feel better.
 Susceptibility is moderate to high on the bases of age, sex, occupation.
 In 2st follow up patient feel 25% better in both knee pain+, shoulder pain+, back pain+
 After that 5th follow up patient feel 50% better in both knee pain++, shoulder pain++ , back
pain++
 After few follow ups complain become aggravated, So Physician gradually increases the
potency (1M). After that patient feel better in knee Pain+, shoulder pain+, back pain+
 Complain become aggravated even after potency of remedy is increase so it needs to give
intercurrent remedy and that was given THUJA.
 No need of any acute remedy.

CASE NO: 04. PHYSICIAN: DR.AMI

D.O.C.: 9/4/’11 DEFINED NO: D: 4214
NAME: H.K.B. AGE: 47 year SEX: Female
EDUCATION: S.S.C. OCCUPATION: Aanganwadi worker
STATUS: married RELIGIOUS: Brahman
VEG/NON-VEG: Veg. SIS: 3 BR: no
SON: NO DAUGHTER: 1
ADDRESS: AMOD

43
CHIEF COMPLAIN:
LOCATION SENSATION MODALITY CONCOMITTENTS
Extremities Pain++ A/F: After cesarean
Lt knee &Calf muscle Swelling++ before 9 year. Appetite- Normal
O: 9 year Crepitation+ <++Walking Thirst- Normal
D: Continuous No tenderness <++ Rest Stool-Normal
F: Daily >++Warm application Urine- Normal
>++Allo. Rx
Heel
O: 2 to 3 year Pain++ <++Walking
D: Continuous No swelling >++Rest
F: Daily No tenderness >++Pressure
>++Warm application

ASSOCIATED COMPLAINTS:
Location Sensation Modality Concomitant
1).Respiratory Snezzing+3 frequent
system Runny nose: watery+ <+++morning
URTI +,thin, <+++sugar, sour, cold
Nose No burning <++Banana, ghee
Itching++ <++ all season
Irritation++

<++when nasal
Eyes Lachrymation++
discharge increase
O: Birth Itching++
<++ morning
D:Continous No burning
<++Walking
F: On& Off
>++Allo.Rx.
Weakness++ (TAB.LOSAKIND,ECOSPM
2).CVS: HTN
Breathlessness++ 15, ROSOVASTUM)
Chest
Pain++
O: 6 month <+++Tension
Pain++ <++shooting
3).Head
Heaviness++ <++Anger
O: 1 year
D: Occ. >++rest
F: 1 year >++silent

4).GIT <++ spicy food

Acidity++
Stomach <++ hot Curd
Burning in chest
O: 7 to 8 year <++ butter milk

44
 D: 2 to 3 min
F : on & off

PHYSICAL GENERAL:
APPEARANCE: Fatty, obese
Perspiration: NAD
APPETITE: Normal THIRST: Normal
CRAVINGS: pungent+++, sweets+++, sour+++
AVERSION: salt++
STOOL: Normal URINE: Normal
Sleep: Normal Dreams: About maternal home.
MENSTURAL FUNCTION:
F.M.P.: 8th STD L.M.P.: 13/3/’11
Menses: Regular Cycle: 30 days Duration: 4 to 5 day
Color: Dark red Stains: present
Concomitants: B.M: Heaviness of body, Bodyache, Itching in vulvae, Lower Abdominal pain
THERMAL: C3H2
WINTER SUMMER MONSOON
FAN 2 5 2
COVER Chadar Chadar Chadar
BATH Hot Warm Warm

PAST HISTORY: NIL

FAMILY HISTORY: MOTHER, SISTER: THYROID

PHYSICAL EXAMINATION:
Weight: 85 kg Temp: AF Pulse: 70/min Tongue: clean Conjunctiva: pink
BP:130/80mmHg

SYSTMIC EXAMINATION:
RS: air - entry: BLE
Breath sound: vesicular
CVS: heart sound: S1, S2: normal

PROVISIONAL DIAGNOSIS:
OA knee with HTN and headache

INVESTIGATION: LIPID PROFILE:

16/8/’14 1/2/’16 28/2/’19
S.CHOLE 260 232 186
S.TRIGLY 115 235 229
HDL CHOLE 54 54 49

45
 LDL CHOLE 183 131 91
VLDL 23 - 45.80
FBS 120 - 91.0
P.P. 234 118.2 -
16/8/’14
BLOOD Ix:
HB: 13.3. MCV: 88.65
WBC: 7600 MCH: 33
RBC: 4.03 MCHC: 37.3
PCV: 35.71 N/L/E/M/B: 60/32/6/2/0
PLATELETS: 330,000

LIFE SPACE:
CHILDHOOD: Patient was born at UKHTALA. After her birth, she was staying at her aunty
(foi). Her parent’s was stay separated because of financial issue between pt’s father & her
uncle. After 2 to 3 year of age her mother left her that time her father was take care of her.
She passed her childhood with her aunty (foi) in SHIHOR. Her aunty’s nature is good. “PANI
MANGE TO DUDH (MILK) APE.” Many conflict in her family. Good IPR with her friends. She
passed her 10th in SHIHOR. Her nature was obstinate. Her nature was funny, mischief. She
became angry when any one not follows her. patient‘s age 16 year her father was expired by
accident. Before 9 months her father death, her parents was reconcile with each other.
Patient is weeping at that time. And then she has become strong. All responsibility takes on
her shoulder. “BHAGVANE JE DHARYU 6 TE THAVANU J 6”.Her youngest uncle take off the all
property for his name.
MARRIAGE LIFE: patient marriage in 20th year of age in AMOD. Her husband has a priest. Her
husband has grossry shop (wholesale). Her husband’s nature is cool& calm. Patient is
youngest daughter in law. Patient stay in join family till 4 year, during that periods many
conflicts occur between family members because pt’s husband didn’t get his proper part in
property. So, that patient feel regrate of that.
Patient become tolerate that people use to tell her or taunt her that in childhood her
mother was not able to maintain relation so then we all three sister (pt & her 2 sister) was
not able to maintain her relation in law’s family.
After her marriage her aunty (foi) was expied in 2004. Patient was felt shock. Not eat for 15
days. She felt helpless that there was no one to help her after death of aunty. She was not
sleep very well. She was worried about her children’s marriage & money matter.
PATIENT AS A PERSON: patient is angry in nature when any one talk to wrong about any
matter. She is irritable in nature. She is sympathetic about beggar.
Patient more attached with her aunty (foi). Patient is anxious about her job. She has perfect
work to time to time. She believes in god.

TOTALITY:

46
 Anger about wrong matter
 Anxious about job
 Perfectionist
 fastidious
 Irritable nature
 Sympathetic nature beggar
 Attached with aunty (foi)
 Believe in god
 Craving: pungent, sweets, sour
 Aversion: salt
 Dream: childhood home
 Chilly patient

REPERTORISATION:
 Mind - Anger
 Mind - anxiety business, about
 Mind - attached
 Mind - irritability
 Mind - perfectionist
 Mind - religious affections
 Mind - sympathetic
 Dreams – home - childhood home, of
 General - food & drinks - pungent things - desire
 General - food & drinks – sour - desire
 General - food & drinks – sweet - desire
 General - food & drinks - salt - aversion
 Chilly patient

REPERTORIAL RESULT:
PULS: 17/11 PHOS: 16/9
N.M.:20/10 SILICEA: 15/8
SULPH: 19/10 KALI P: 11/9
LYCO: 17/9 N.V.:19/9

REASON OF SELECTION OF REMEDY: Fastidious

Perfectonist
Responsible
Sympathetic
Anxiety: about business
Desire: pungent, sweet
Chilly pt

47
PLANNING AND PROGRAMMING:
DEFINE WITH REASONS THE STATE POTENCY-CHOICE REPETITION
1.SUSCEPTIBILITY : low to moderate
Age- 47 age
Sex-female
seat of disease- structure irreversible
pace of disease- slow 30 Infrequent
2. SENSITIVITY( MIND & NERVES)
Mind+, Nerves++ 30 Infrequent

3. SUPPRESSIONS (IF ANY)SSS -- --

No
4. CORRESPONDANCE (DEGREE & LEVEL) CONST. Rx
Mental++, Physical+ SILICEA Infrequent
5. CORRESPONDANCE (DEGREE & LEVEL) SECTOR Rx --
--
6. CORRESPONDANCE (DEGREE & LEVEL) INTER-CURRENT Rx Infrequent
THUJA 1M
7. FUNCTIONAL CHANGES Infrequent
Present 30
8. STRUCTURAL CHANGES Infrequent
Structure irreversible 30
9. VARIATIONS( WITH TIME) -- --
10. GENERAL VITALITY Infrequent
Good 30
11. PRESENTATION-
A. FUNDAMENTAL MIASM 30 Infrequent
SYCOTIC
B. DOMINANT MIASM
SYCOTIC 30 Infrequent
C. SECTOR (ACUTE/EXACERBATION) -- --
D. RECENT GROUP (STATE FROM-----) -- --
E. CONFUSED -- --

FIRST PRESCRIPTION: SILICEA 30 3P HS

SL 3 pills TDS
PT 1x1x1 / 2wks

CRITERIA:
1. Knee Pain I/F/D Rt/Lt

48
 2. Heel Pain
3. Cough/Cold
4. Headache
5. Chest Pain
6. Acidity
7. O/E Knee Swelling, Weight, BP, Pulse

FOLLOW UPS:
DATE 1 2 3 4 5 6 7 PRESCRIPTION
30/4/’11 >++ >++ 0 0 >+ 0 BP:130/80mmHg SILICEA 30 3P HS
P:70/min ii 3 pills TDS
Swelling >++ PT 1x1x1 /2wks
14/5/’11 >++ >++ 0 >++ >++ >++ BP:140/80mmHg SILICEA 30 3P HS
P:72/min ii 3 pills TDS
Wt:85 kg PT 1x1x1 /2wks
28/5/’11 >+3 >++ <+ >+3 >+ >+ BP:120/80mmHg SILICEA 30 3P HS
80% P:70/min ii 3 pills TDS
Wt:85 kg PT 1x1x1/2wks
11/6/’11 <+ <+ >+ <++ >+ >+ Swelling: present THUJA 1M 1P HS
BP:130/80mmHg SILICEA 30 3P HS
ii 3 pills TDS
PT 1x1x1 /2wks
25/6/’11 >++ >++ >+3 >++ >+ >+ Swelling: >+ THUJA 1M 1P HS
BP:130/80mmHg SILICEA 30 3P HS
ii 3 pills TDS
PT 1x1x1/2wks
9/7/’11 >++ >++ >++ >++ <+ 0 BP:130/80mmHg THUJA 1M 1P HS
SILICEA 30 3P HS
ii 3 pills TDS
PT 1x1x1/4wks
30/7/’11 >RT >++ >++ >++ <+ 0 BP:140/90mmHg THUJA 1M 1P HS
<Lt P:80/min SILICEA 30 3P HS
ii 3 pills TDS
PT 1x1x1 /2wks
6/8/’11 <+ >+3 0 0 >+ <+ BP:130/90mmHg SILICEA 30 3P HS
Ii 3 pills TDS
PT 1x1x1/ 4 wks
7/9/’11 >+ >+ 0 0 >+ >+ KALI CARB 200 3piis
Rectal: stitching type pain++, burning. No bleeding. <+after QDS/ 3days
passing stool, sitting, walking, >++warm application PT 1x1x1/ 1st week
SILICEA 30 3P HS

49
 Ii 3 pills TDS
PT 1x1x1 / 2nd week
8/10/’11 >++ >++ 0 0 >++ >+ Rectal pain >25% SILICEA 30 3P HS
Ii 3 pills TDS
PT 1x1x1 / 4 wks
7/4/’12 >+ >+ 0 0 0 >++ Knee swelling = THUJA 1M 1P HS
A/F: sitting for SILICEA 30 3P HS
long time ii 3 pills TDS
BP:140/80mmHg PT 1x1x1 /6 wks
Wt:89 kg
18/8/’12 >++ >++ 0 0 0 >++ BP 120/70mmHg THUJA 1M 1P HS
SILICEA 30 3P HS
ii 3 pills TDS
PT 1x1x1 /2wks
31/1/’13 >++ 0 <+ <+ 0 >+ SILICEA 30 3P HS
ii 3 pills TDS
PT 1x1x1 /6 wks
After 8 month no any complain
9/11/’13 Lt+2 0 0 >+ >+ 0 Mild swelling+ SILICEA 200 1P HS
>Rt+ No crepitation PT 1x1x1/ 1wks
Wt: 90kg
16/11/’13 S.Q. 0 >++ >++ 0 0 THUJA 1M 1P HS/1st
& 3rd wk
SILICEA 200 1P HS
ii 3pills TDS
PT 1x1x1 /4 wks
4/1/’14 >++ 0 <+ 0 0 0 BP:130/70mmHg ARS.ALB 200 3 pills
Runny nose+3. since 10 days = thin/w, sneezing+3, throat: QDS/ 3 days
soreness++, >+ warm drink, Thirst: incrase+3,large quantity, SILICEA 200 1P HS
Nose: polyp=Rt side ii 3 Pills TDS
PT 1x1x1/ 4 wks
13/2/’14 >++ 0 >++ 0 0 0 SILICEA 200 1P HS
ii 3 Pills TDS
PT 1x1x1/ 5 wks
12/4/’14 >+ 0 >++ 0 0 0 BP:130/80mmHg THUJA 1M 1P HS/1st
wk
SILICEA 200 1P HS
ii 3pills TDS
PT 1x1x1 /4 wks
1/5/’14 S.Q. S.Q. >++ >+ 0 0 Swelling Rt>Lt ii 1P Hs
BP 130/90mmHg BRYONIA 200 TDs

50
 Knee pain: Rt+>Lt. since 1wk, throbbing pain.<walking, PT 1x1x1/2wks
sitting,>balm, warm application.
Headache=vertex, throbbing pain
29/5/’14 <++ >+ >++ >+ >+ 0 THUJA 1M 3P HS
SILICEA 1M 1P HS
ii 3pills TDS
PT 1x1x1 /4 wks
9/8/’14 >++ >++ >+ >+ >+ 0 BP:150/80mmHg THUJA 1M 1P HS
SILICEA 1M 3P HS
ii 3pills TDS
PT 1x1x1/2 wks
15/10/’16 >+ >+ >+ >+ 0 0 Swelling heel ii 7P HS
BP:136/76mmHg ii 3piilsTDS/ 1wk
Wt:94/kg
10/11/’16 <+ S.Q. 0 >+ >+ >+ BP:130/80mmHg THUJA 1M 1P HS
Wt: 93 kg SILICEA 1M 3P HS
ii 2x2x2 TDS
CALC PHOS 6X 1x1x1
/2 wks
10/12/’16 >+ >+ 0 >+ >+ >+ Swelling ++ THUJA 1M 1P HS
SILICEA 1M 3P HS
Ii 3 pills TDS
MAG PHOS 3x3x3/
2 wk
24/12/’16 >++ >+ >+ >+ >+ 0 ARS.ALB 200 9P
Runny nose= thin, watery, dry cough++=<+cold water, TDS/ 3days
morning, night, >+warm drink. Thirst= increase, Aver: Fan. Ii 3pills TDS/ 1st wk
SILICEA 1M 3P HS
Ii 3pills TDS/ 2nd wk
7/1/’17 >++ 0 >++ >+ 0 0 THUJA 1M 1P HS
SILICEA 1M 3P HS
Ii 3 pills TDS /8 wk
11/3/’17 >++ 0 0 >++ 0 0 Crepitation=Rt>Lt THUJA 1M 1P HS
Wt: 97kg SILICEA 1M 3P HS
BP:122/72mmHgP ii 3 pills TDS /8 wk
:82/min
24/4/’17 >++ >+ 0 S.Q. 0 0 BP: 130/84 kg SILICEA 1M 3P HS
Knee pain=Taken ii 3 pills TDS/4 wks
physiotherapy
10/6/’17 S.Q. S.Q. >+ >+ 0 0 BP:130/90mmHg THUJA 1M 1P HS
SILICEA 1M 3P HS

51
 ii 3 pills TDS /8 wk
4/11/’17 S.Q. >+ >+ S.Q. 0 0 BP:130/80mmHg THUJA 200 1P HS
Wt:93 kg SILICEA 30 6P HS
SL TDS/4 wks
2/12/’17 >+ >+ >+ >++ 0 Occ. THUJA 200 1P HS
SILICEA 30 6P HS
SL TDS/4 wks
30/12/’17 >+ >+ >+ >++ 0 0 BP:140/100mmHg SL 200 1P HS
SL 200 3pills
TDS/4wks
6/1/’18 S.Q. S.Q. >+ >+ 0 0 BP:134/90mmHg SILICEA 30 7p
HS/wkly
SL TDS/ 3 wks
3/2/’18 S.Q. S.Q. >++ S.Q. >+ 0 BP:132/86mmHg THUJA 1M 1P HS
Wt: 92.5kg SILICEA 30 BD
SL TDS/ 8wks
14/4/’18 >+ S.Q. 0 >++ >+ 0 Wt: 93.3 kg THUJA 1M 1P HS
20% SILICEA 30 3pills BD
SL TDS/ 8wks
30/6/’18 >+ >+ 0 Occ. Occ. 0 BP:130/80mmHg SILICEA 30 BD
Wt: 95kg SL 1P HS
SL 3pills TDS/ 4 wks
25/8/’18 >+ >+ 0 >+ >+ 0 BP:124/80 mmHg THUJA 1M 1P HS
SILICEA 30 TDS
/ 4wks
22/9/’18 >+ S.Q. >+ S.Q. >+ 0 BP:120/86mmHg THUJA 1M 1P HS
Wt: 96 kg SILICEA 200 1P HS
SL TDS/ 4wks
20/10/’18 <+ <+ <+ S.Q. >+ Occ. BP:130/80mmHg RHUS TOX 0/1 7P HS
Cold & cough: since 15 days, Ear pain: throbbing pain, cold: 1 PKT= BD
watery discharge , A/F: sweet (khir, jalebi) SL TDS/ 4wks
Sneezing++:<++ morning, no throat pain
27/10/’18 >+ S.Q. <++ <+ >+ O BP:130/90mmHg ARS. ALB 200 9P
Cold & cough, sneezing, throat pain, earache, hoarseness of TDS/ 3days
voice= since 1 wk, urine pass while coughing, cough: white SL TDS/ 1week
expectoration,<++ talking, night, >++warm food & drink
dryness of mouth, App: increase, Thirst: increase, large
quantity of small interval, aversion : fan
17/11/’18 >+ >+ >+ S.Q. >+ 0 P: 83/min ARS ALB 200 9P HS
BP:140/80mmHg 1x1x1/ 3 days
Cough: Rattling cough, <+ lying down, no expectoration, THUJA 1M 1P HS

52
 Throat pain: >warm water, eye heaviness, weakness, thirst: SIL 200 1P HS
increase SL 3pills TDS/4 wks
15/12/’18 >++ >+ >+ <+ >+ 0 BP:140/100mmHg THUJA 200 3P HS
O/E: swelling wkly
Headache: A/F: stress++ SILICEA 30 3pills TDS
SL TDS
NAT PHOS 6X
2x2x2 /5 wks
19/1/’19 >+ >++ >++ >++ >++ 0 BRYONIA 200 3pills
Knee pain: Popliteal fossa, sudden pain,<: standing with TDS
work, touch > standing still NAT PHOS 6X 2x2x2
SL TDS/ 2wks
16/2/’19 >++ >++ >++ >++ 0 0 THUJA 200 3P
HS/wkly
SILICEA 30 3 pills
TDS
SL TDS
NAT PHOS 6X
2x2x2 /5 wks
30/3/’19 S.Q. S.Q. <+ >+ 0 0 P: 74/min THUJA 200 3P
BP: 130/90mmHg HS/wkly
Wt: 99 kg SILICEA 30 3 pills
HTN: LOSAKIND H, TELMIRIDE CH 12.5 , ATROVASTATIN & TDS
ASPIRIN CAPSULES SL TDS
NAT PHOS 6X
2x2x2 /5 wks

Conclusion:
 After case definition prescribe SILICEA as a constitutional remedy in low potency.
 In a next follow up patient complain better 50% in both knee pain+, heel pain++, headache+
+, acidity++, chest pain++, knee swelling++. So continue same treatment.
 In 3rd follow up pt complain 80% better in knee pain++, heel pain++, headache++, knee
swelling++, headache+, chest pain+, heel pain+.
 In 4th follow up pt complain aggravation so given THUJA 1M because pt better feel after first
but in subsequent follow up pt not feel well so also one possibility of miasmatic block, from
this aspect given THUJA as a intercurrent remedy.

53
 Then patient feel better in knee pain, and & knee swelling after change also SILICEA potency
increase & then pt feel better in almost all complain better.
 In this case also acute complain so according to acute totality give KALI CARB, ARS ALB,
BRAYONIA.
 According to age of patient weight was more so, there was take a time for a relief Inspite of
regular treatment of CR.

CASE: 05. PHYSICIAN: DR.DGN

D.O.C.: 18/12/’17 DEFINED NO: D: 10280
NAME: P.G.I. AGE: 70 year SEX: MALE
EDUCATION: M. A, B.Eed. OCCUPATION: Retired teacher
STATUS: Widow RELIGIOUS: Muslim
VEG/NON-VEG: ALL SIS: 4 SON: 1
ADDRESS: Ikhar

CHIEF COMPLAIN:
LOCATION SENSATION MODALITY CONCOMITTENTS

54
 1. Mss Pain++ <++Bending Knee App- Normal
Extremities Heaviness of Leg While Namaj Thirst- Normal
Right Knee Joint No Radiating Pain <++Damp Wet Urine- Normal
Medial Side No Swelling & Weather Stool- Normal
Rt>Lt Redness >+Warm Sleep- Normal
O: 2 Year Application
D: Continue >+Allo Rx

2.All Joint
Elbow,Ankle,Wrist, Pain++ <++C.O.W. Weakness
Back No Swelling <++Cold Weather
O: 2 Year No Radiating Pain >++Warm
Application

PHYSICAL GENERAL:
APPEARANCE: whitish complexion, medium built
PERSPIRATION: Profuse++ - face+3, axilla+3.
APPETITE: Normal THIRST: Normal
CRAVINGS: sweets+3, sour+ +, Meat+++
AVERSION: spicy+, Fish++
STOOL: Normal URINE: Normal
Sleep: good DURATION: 6 hours
Dreams: Daily routine
THERMAL: C3H2
WINTER SUMMER MONSOON
FAN 0 5 3-4
COVER Blanket Chadar Blanket
BATH Warm Warm Warm

PAST HISTORY: NIL

FAMILY HISTORY: MO: DM, FA: TB

PHYSICALEXAMINATION:
Weight: 74 kg Temp: A/F Pulse: 82/min Tongue: pink Conjunctiva: pink Nail: pink

SYSTEMIC EXAMINATION:
RS: Air - entry: BLE
CVS: S1, S2: NAD
MSS: ROM: NAD
Swelling: No swelling

55
 Crepitation: RT++ > LT++

PROVISIONAL DIAGNOSIS:
B/L Moderate Osteoarthritis knee

INVESTIGATION:
RADIOLOGICAL: X-RAY- both knee: Narrowing of medial spaces with tibial spiking is seen.
S/O bilateral moderate OA knee
Show subarticular irregular shape focal sclerosis lesion.

LIFE SPACE:
CHILDHOOD: patient was born at valsad in 1947. His family consists of father, mother, 1
elder sister, 3 younger sisters. 2nd sister was expired due to some kidney problem. Father
was primary teacher. He was good by nature. Father was expired in 1963 because of TB.
That time patient was in 10th STD. patient was good IPR with father. After father’s death all
responsibility of house was came on patient because he was only man person in his family.
Mother was also good by nature. She was a primary teacher so she always be with patient in
took responsibility of own home. Patient has good IPR with mother. Mother was expired in
1976 because of DM. After that patient have 16 vigha land in his village, so, that time patient
has taken both responsibilities. One sided study and other side farming. Good IPR with all
sisters.
SCHOOL LIFE: Patient studied till M.A Bed in English. Pt 1 st to 4th Std studied in valsad than
after 5th to 7th std studied in Ikhar. 8th & 9th Std in Amod. 10th & 11th std at palej. B.A. in
Bharuch & M.A. in Vadodara. During school time patient have many friends, good IPR with
them. Patient has brilliant student in school. He got a 1 st& 2nd rank in class. Patient has liked
to participate in other school activity but he can’t because of daily up down he has not
managed the time.
MARRIAGE LIFE: Patient got married in 1969. Patient’s wife nature was good. She was good
IPR with patient and MIL also, never conflict occur between them. Patient has 1 son, he was
expired in 2001, at the age of 30 year. His son was very good by nature, hardworking. He
was chemical engineer and he worked in GNFC company, in their blast occur and his son
expired Patient has a grief for son’s death. But he accepts all thinks because patient believes
in nature or god. Now patient is lives with his DIL and 2 granddaughters& 1 grandson.
PATIENT AS A PERSON: pt’s nature cool & calm .he is adjustable all time in all circumstance.
Pt takes all responsibility in early age. Pt has a good memory. Pt have an anxiety or
ambitious about his grandson’s future. He more attach with him.pt has like to work perfect.
He said ‘KOI PAN PARISTHITI HOY SAMNO KARVA PEHLE THI TYAR REHVANU.’ He takes
patience for face the all problem.

TOTALITY:
• Cool & calm+3

56
• Responsible+3
• Perfectionist+3
• Memory sharp+2
• Patience+3
• Positiveness+
• Ambicious+3 for his grand son
• Believe in nature++(god)
• Dreams of daily routine+
• Cr- sweets+3, sour+, meat+++
• Av- spicy+, fish+
• Perspiration- profuse++ - face+3, axilla+3
• Sleep on side- disturbed by noise
• Chilly patient

REPERTORISATION:
 mind – Tranquility, calmness
 mind – responsibility- taking responsibility to seriously
 mind – fastidious
 mind – memory- active
 mind- Patience
 mind- positiveness
 general – food & drink- pungent thing- aversion
 general – food & drink- sweets- desire
 general- food & drink- sour food- desire
 general- food & drink- meat – desire
 general- food & drink- fish - aversion
 perspiration- profuse
 face- perspiration
 chest- perspiration- axillae
 sleep- position- side on
 sleep- disturbed- noise by the slightest
REPERTORIAL RESULT:
SULPH: 22/12 LYCO: 18/9
PHOS: 19/12 NAT.M: 17/9
ARS: 18/11 SIL: 16/9
LACH: 17/11 CAL.C: 17/8
KALI.P: 12/10

REASON OF SELECTION OF MEDICINE: take responsibility seriously and early

Perfectionist+
Adjuctable+3

57
 Well- behavior+
CR: sweet
Knee pain: <+ cold weather
Perspiration- profuse- on face
Chilly patient

PLANNING AND PROGRAMMING:

DEFINE WITH REASONS THE STATE POTENCY-CHOICE REPETITION
1.SUSCEPTIBILITY Low
Age- 70 year 30 Infrequent
Sex- male
Seat of disease-structural irreversible
pace of disease- gradual
3. SUPPRESSIONS (IF ANY) -- --
4.CORRESPONDANCE (DEGREE & LEVEL) CONST. Rx
mental++, physical++ SILICEA 30 Infrequent

5.CORRESPONDANCE (DEGREE & LEVEL) SECTOR Rx ̶ --

6.CORRESPONDANCE (DEGREE & LEVEL) INTER-CURRENT Rx --
7. FUNCTIONAL CHANGES -- --
8. STRUCTURAL CHANGES Low 30 Infrequent
Irreversible changes
9. VARIATIONS (WITH TIME) -- --
10. GENERAL VITALITY Infrequent
Good 30
11. PRESENTATION- Infrequent
A. FUNDAMENTAL MIASM Low 30 Infrequent
SYCO TUBERCULAR
B. DOMINANT MIASM Infrequent
SYCOTIC Low 30
C.SECTOR -- --
(ACUTE/EXACERBATION)
D.RECENT GROUP(STATE FROM-----) -- --

E. CONFUSED -- --

FIRST PRESCRIPTION: SILICEA 30 3p HS

SL 3 pills TDS/ 1 wk

CRITERIA:
1. Pain-Knee-Right

58
 2. Pain-Knee-Left
3. Heaviness of Leg (Right Side)
4. O/E: Crepitation
5. Swelling
6. Tenderness

FOLLOW UPS:
DATE 1 2 3 4 5 6 PRESCRIPTION
25/12/’17 >+10 >+10% >+ S. Q 0 >+ SILICEA 30 3p HS
% SL 3 pills TDS/ 2 wks
09/1/’18 >++ >++ >+ S. Q 0 >+ SILICEA 30 3p HS
50% 50% SL 3 pills TDS/2 wks
22/1/’18 >++ >++ >+3 Rt+/Lt+ 0 0 SL 3p HS
SL pills TDS x 7 days/ 2 wks
12/2/’18 >+ >+ 0 Rt+/Lt+ 0 0 SILICEA 30 3p HS
SL 3 pills TDS/ 4 wks

CONCLUSION:

• In this case first prescription is SILICEA 30 3p HS for 1 wk. patient feel better 10% in both
knee pain, heaviness of leg, tenderness but crepitation is S.Q.
• After repeating the SILICEA remedy patient feel better 50% in both knee pain++, heaviness
of leg++,tenderness+ and no swelling
• After repeating the same prescription, patient gets better 80% in both knee pain++,
heaviness of leg++, crepitation+
• SILICEA also help in removing sclerosis (abnormal hardening of bony tissue=knee joint) that
was present in this case.
• Susceptibility is low according to the age, sex, and disease. Dominant miasm is Sycotic.
• No need acute remedy

59
CASE NO: 06. PHYSICIAN: DR.AMI
D.O.C.: 13/12/’18 DEFINED NO: D: 11211
NAME: M.A.M. AGE: 50 year SEX: Male
EDUCATION: 10th pass OCCUPATION: Farmer
STATUS: Marriage RELIGIOUS: Muslim
VEG/NON-VEG: All
SON: 2 SIS: NO BR: 4
ADDRESS: ANTI

CHIEF COMPLAIN:
LOCATION SENSATION MODALITY CONCOMITTENTS
MSS Pain++ Bruised <++Bending knee APP – Normal
Knee joint No crepitation <++Sitting Thirst - Normal
O:2 year No swelling <++up & down stair Stool - Normal
D: 2 to 3 sec. >+Allo. Rx. Urine – Normal
F: on& off >++Rest

ASSOCIATED COMPLAINTS:
Location Sensation Modality Concomitant
GIT Burning in chest A/F: spicy food,
O: 2 year Sweet, oily food
D: 10 to 15 min >Milk
F: on & off

PHYSICAL GENERAL:
APPEARANCE: Wheatish complexion
Perspiration: whole body, offensive+
APPETITE: Normal
THIRST: Normal
CRAVINGS: NAD
AVERSION: NAD
STOOL: Normal URINE: Normal
Sleep: Normal. Light, Noise: disturbed
THERMAL: C3H2
WINTER SUMMER MONSOON
FAN No 4-5 3-4
COVER Chorso No Thin
BATH Cold Cold Tepid

PAST HISTORY: NAD

60
FAMILY HISTORY: NAD

PHYSICAL EXAMINATION:
Weight: 50 kg Temp: AF Pulse: 70/min Tongue: pink, moist Conjunctiva: pink
SYSTMIC EXAMINATION:
RS: air - entry: BLE
Breath sound vesicular
MSS: both knee joint
ROM: NAD
No swelling
No crepitation

PROVISIONAL DIAGNOSIS: Bilateral mild OA knee

INVESTIGATION:
RADIOLOGICAL: X ray both knee joint: Narrowing of medial joint spaces is seen.
S/O: bilateral mild OA.

LIFE SPACE:
A 5o year patient came in OPD with complain of knee joint pain since 2 years.
CHILDHOOD: pt’s born at ANTI village in his maternal Grandfather’s (nana) home that time
his family consist of GFa, GMo, Fa, Mo. Good IPR with all family members. His father’s
nature has quiet but sometime anger when patient not listen his father. His father has
farmer. His mother’s nature is cool & calm. She has house wife. His financial condition was
medium at that time.
SCHOOL LIFE: patient studied till 5thstd at his village and after he went 5 th to 10thstd in at
sandhi village. Good IPR with all school friends and school teachers. Patient was medium in
study. He got 50% in 10th std. He take participate in volleyball, kabbadi and cricket like sports
activities. He has 3 to 4 school friends. Now a day they also talk with each other. After 10 th
std, he left the study because of patient was medium in financial condition. He has 4
younger brother and he join to the farmer work.
MARRIAGE LIFE: In 1985, patient got married. His wife’s nature is angry. Specially with
children, as they fight with each others. He has good IPR with all brothers. Patient is stay
with his 2 son. One elder son is married and doing job in one company. His younger son has
job in Bank. Younger son is quite irritable. Now a day patient is staying with his wife and
doing farming on 5 vigha land.
PATIENT AS A PERSON: Patient is cool & calm in nature. He has anxious about his farmer
work. He frequently thinks about the farming work (1000times) taking any decision that time
he takes advice (solution) of all family members in any decision. Patient has sharp memory.
He is sympathetic in nature.

61
 TOTALITY:
 Cool & calm
 Anxiety about farming work
 Sympathetic nature
 Easily communicative
 Decision taking with support
 Sharp memory
 Think about farmer work
 Sleep disturbed noise, light
 Perspiration: offensive
 Perspiration: better after bathing
 Chilly patient

REPERTORISATION:
 Mind - Tranquility
 Mind - Decisive
 Mind - Communicative
 Mind – Memory - Active
 Mind - Talkative
 Mind - Thoughts - About Business
 Sleep – Disturbed - Noise
 Sleep – Disturbed - Light
 Perspiration - Odor - Offensive
 Perspiration - Washing - Amelioration
 Chilly Patient

REPERTORIAL RESULT:
N.V.:12/5 SILICEA: 8/6
PHOS: 11/6 SULPH: 9/5
PULS: 10/5 CALC: 7/6

REASON OF SELECTION OF MEDICINE: Cool & Calm

Talkative
Hardworking
Responsible
Perspiration: Profuse
Chilly Patient

PLANNING AND PROGRAMMING:

DEFINE WITH REASONS THE STATE POTENCY-CHOICE REPETITION
1.SUSCEPTIBILITY Moderate to Low Infrequent
Age-50 year 30

62
 Sex-Male
Occupation: farmer
seat of disease- structure irrversible
pace of disease- gradual
2. SENSITIVITY( MIND & NERVES) Infrequent
Mind+ 30
Nerves++
3. SUPPRESSIONS (IF ANY)SSS -- --
No
4. CORRESPONDANCE (DEGREE & LEVEL) CONST. Rx Infrequent
Mental+, Physical++ SILICEA
5. CORRESPONDANCE (DEGREE & LEVEL) SECTOR Rx --
--
6. CORRESPONDANCE (DEGREE & LEVEL) INTER-CURRENT Rx --
--
7. FUNCTIONAL CHANGES
Present 30 Infrequent

8. STRUCTURAL CHANGES 30 Infrequent

Irreversible

9. VARIATIONS( WITH TIME) -- --

10. GENERAL VITALITY 30 Infrequent
Good
11. PRESENTATION- 30 Infrequent
A. FUNDAMENTAL MIASM
PSORA
B. DOMINANT MIASM 30 Infrequent
SYCOTIC
C. SECTOR (ACUTE/EXACERBATION) -- --
D. RECENT GROUP (STATE FROM-----) -- --
E. CONFUSED -- --

FIRST PRESCRIPTION: SILICEA 30 3P HS

CALC.PHOS 6X 2x2x2
SL TDS/1 wk

CRITERIA:
1. Knee Pain: Rt= I/F/D
2. Knee Pain: Lt= I/F/D
3. Burning In Chest
4. O/E: Crepitation,
63
 5. Swelling,
6. ROM,
7. Weight.

FOLLOW UPS:
DATE 1 2 3 4 5 6 7 PRESCRIPTION
20/12/’18 >+10% >+10% >++ 0 0 >+ Wt:50 kg SILICEA 30 3P HS
CALC.PHOS 6X 2x2x2
SL TDS/2 wk
21/2/’19 >+20% >+20% 0 0 0 Wt:53kg SILICEA 30 3P HS
CALC.PHOS 6X 2x2x2
SL TDS/4 wk

CONCLUSION:
 After case definition prescribe SILICEA as a constitutional remedy in a low potency.
 In this case susceptibility is low to moderate according to age, sex, seat of disease and pace
of disease.
 In next follow up patient complain better 10% in both knee pain, acidity, after give SILICEA
remedy. So continue same treatment given.
 After patient take not remedy for a few weeks after that he came again.
 In 2nd follow up pt feel 20% better in both knee pain+, no swelling
 Patient feel relieved in acidity, crepitation, knee swelling.
 SILICEA help in improving joint space so that it can help in improving function of bone.

CASE NO: 07. PHYSICIAN: DR.AMI

D.O.C.: 9/4/’15 DEFINED NO: D: 7075
NAME: S.S.R. AGE: 72 year SEX: Female
64
EDUCATION: 3rd std OCCUPATION: Housewife
STATUS: married RELIGIOUS: Hindu
VEG/NON-VEG: Veg.
SON: 4 SIS: 3 BR: 1
ADDRESS: KARJAN.

CHIEF COMPLAIN:
LOCATION SENSATION MODALITY CONCOMITTENTS
MSS Pain++ <+3getting up after
Both knee joint Stiffness+3 sleeping
O: 15 to 20 year. No T&N <+3sour food
D: continuous Occ. Swelling <++ walking
F: on/off Movement <++up stair
restricted. <++ heavy weight
lifting
<++damp cloudy
weather
>++ warm water
>+massage

ASSOCIATED COMPLAINTS: NIL

PHYSICAL GENERAL:
APPEARANCE: wheatish complexion
Perspiration: General: scanty, Partial: Forehead+, Back+
Stain: white staining delible
APPETITE: Good STOOL: Normal
THIRST: Normal URINE: Normal
CRAVINGS: Salt++, sweets++, Sour+3, pungent++
AVERSION: Milk++
Sleep: Normal Dreams: Snakes++
MENSTURAL FUNCTION:
F.M.P.: Not know Menopause: 25 years
Menses: Regular Cycle: 28 days
Color: Dark red Stains: yellowish, Non delible
Concomitants: B.M: genital itching++
Sun <++ headache, vomiting
THERMAL: C2H2
WINTER SUMMER MONSOON
FAN 0 3 0
COVER RAJAI 0 CHADAR

65
 BATH Tepid Cold Tepid
PAST HISTORY: NIL
FAMILY HISTORY: father: heart problem, mother: OA knee
Sister: convulsion

PHYSICAL EXAMINATION:
Weight: 60 Kg Temp: AF Pulse: 86/min Tongue: Pink, clean moist Conjunctiva: Pink
SYSTMIC EXAMINATION:
RS: breath sound: vesicular
Air - entry: BLE
P/A: soft
MSS: Crepitation+3 Rt = Lt
ROM: Restricted at 65 ͦ
No swelling
No warmth

PROVISIONAL DIAGNOSIS: Bilateral OA knee

INVESTIGATION: NAD

LIFE SPACE:
CHILDHOOD: Patient was live in MITHLAPOOR, VIRAMGAV Taluka. Patient was live with her
Foi, uncle. But later then she separate. Mother is anger by nature. Sometimes she anger on
patient. Father is also good in nature. Never fight with pt. patient’s social condition is good.
Sometime fight with her brothers when meet together. Father was death by attack. Mother
suffering from paralysis & then off.
SCHOOL LIFE: Patient study std 3 rd then left because further study available so far from the
village.
MARRIAGE LIFE: She got marriage at the 16 year of age. She lives in VINCHHAN village. She
stay there up to 2 to 3 years. Her family consist MIL, FIL, Elder & Young BIL & SIL. Her FIL is
good by nature. Her Elder BIL is doing own shop of grossary. Her younger BIL is also doing
business. Good IPR with her family member. Patient do own work by own mind. MIL is
irritable by nature & she irritable in small matters of household work like “TOKIYA KRE”. Her
MIL give to all time order to patient. Fight with all time with everyone. FIL is good in nature.
Never conflict occurs in law’s family.
Then, they shifted different different places like vijapur, Aarij, Jambusar vaghodiya & karjan.
Because of the husband’s job. Now, he retired up to 15 to 20 yrs. No any problem face to
patient about shiftness. She has 4 sons. All are married. Her DIL & son are good by nature.
They never give any difficulty to her. Her 1 st son is doing business at vadodara & 2nd son also
doing business at karjan. Her husband is irritable by nature. He irritable when he says
something to do, but patient that time not listens properly. When he irritated that time pt
also feel anger & suppressed. Many time she express her anger on her husband. Her father

66
 died before 20 to 22 yrs due to heart attack. Mother died before 15 to 17 yrs due to
paralysis but no any affect on pt mind.
PATIENT AS A PERSON: She is very sympathetic in nature. She has fear of thief. Patient can’t
live alone. No fear of dark & ghost. She is helping in nature.
HUSBAND’S INTERVIEW: He said pt is irritable by nature. She has irritable when not done
anything according to her. So her reaction is outspoken. She anxious when any family
member not comes on time at home. She is very perfectionist & fastidious. She always work
by self but when she give any order or instruction to her that time not works on time. So she
not say anything to anyone but do work own.

TOTALITY:
 Anxiety : about family member
 Irritable: spoken out
 Irritable: not done anything according to her
 Perfectionist++
 Memory: sharp
 Sympathetic nature
 Fear: alone+, robbery+
 Dream: snakes++
 Perspiration: forehead, back
 Craving: salt++, sweet++, sour+3, pungent++
 Aversion: milk++
 Sun: headache++, vomiting
 chilly patient

REPERTORISATION:
 Mind – Anxiety - Family, About
 Mind - Sympathetic
 Mind - Perfectionist
 Mind – Irritability - Spoken To
 Mind - Memory - Active
 Mind – Fear - Alone, Of Being
 Mind - Fear - Robbers, Of
 Head - Sun Exposure To - The Sun - Aggravation
 Face - Perspiration - Forehead
 Back - Perspiration
 Dreams - Snakes
 Generals - Food & Drinks – Pungent - Desire
 Generals - Food & Drinks – Sour - Desire
 Generals - Food & Drinks – Sweets - Desire
 Generals - Food & Drinks – Salt - Desire

67
 Generals - Food & Drinks - Milk - Aversion
 Chilly Patient

REPERTORIAL RESULT:
PHOS: 24/11 SILICEA: 14/10
SULPH: 18/11 N.V.:13/9
PULS: 16/11 CALC: 15/9
ARS: 16/10 LYCO: 16/9

REASON OF SELECTION OF REMEDY: irritability: spoken out

Memory: active
Fear: alone, robbers
Perspiration: back+
Dream: snakes
Craving: sweets+, salt+
Aversion: milk
Chilly patient

PLANNING AND PROGRAMMING:

DEFINE WITH REASONS THE STATE POTENCY-CHOICE REPETITION
1.SUSCEPTIBILITY Low to moderate
Age- 72 yrs Infrequent
Sex- female 30
seat of disease- structural irreversible
pace of disease- gradual
2. SENSITIVITY( MIND & NERVES) Infrequent
Mind+, Nerves++ 30
3. SUPPRESSIONS (IF ANY)SSS -- --
No
4. CORRESPONDANCE (DEGREE & LEVEL) CONST. Rx Infrequent
Mental++, physical+ SILICEA
5. CORRESPONDANCE (DEGREE & LEVEL) SECTOR Rx --
--
6. CORRESPONDANCE (DEGREE & LEVEL) INTER-CURRENT Rx Infrequent
THUJA 200
7. FUNCTIONAL CHANGES Infrequent
Present
8. STRUCTURAL CHANGES 30 Infrequent
Irreversible
9. VARIATIONS( WITH TIME) -- --
10. GENERAL VITALITY 30 Infrequent

68
 Good
11. PRESENTATION- Infrequent
A. FUNDAMENTAL MIASM 30
SYCOTIC
B. DOMINANT MIASM 30 Infrequent
SYCOTIC
C. SECTOR (ACUTE/EXACERBATION) -- --
D. RECENT GROUP (STATE FROM-----) -- --
E. CONFUSED -- --

FIRST PRESCRIPTION: SILICEA 30 TDS

SL 2 pills TDS
PT 1x1x1/ 2 wks

CRITERIA:
1. Knee Pain: I/F/D
2. Stiffness
3. Knee O/E: crepitation,
4 : Swelling
5. BP, Pulse

FOLLOW UPS:
DATE 1 2 3 4 5 PRESCRIPTION
30/4/’15 S.Q. >+ Rt=Lt:++ 0 BP: SILICEA 30 TDS
120/60mmHg SL 2 pills TDS
PT 1x1x1/ 2 wks
14/5/’15 >+ >+ Rt=Lt:++ 0 THUJA 200 3P
HS /wkly
Difficulty in walking after sitting long. SILICEA 30 2x2x 2
II 2x2x2/ 2 wks
28/5/’15 >+ >+ Rt=Lt:++ 0 THUJA 200 3P
HS /wkly
SILICEA 200 3P
HS /wkly
II 2x2x2/ 1 wks
4/6/’15 >++ >++ 0 THUJA 200 3P
(R) 50% 50% HS /wkly
SILICEA 200 3P
HS /wkly
II 2x2x2/ 2wks
18/6/’15 >+ >+ Lt++>Rt+ 0 BP:100/60mmHg THUJA 200 3P

69
 HS /wkly
SILICEA 200 3P
HS /wkly
II 2x2x2/ 2wks
2/7/’15 >++ >++ Lt>Rt 0 BP:110/70mmHg THUJA 200 3P Hs
/wkly
SILICEA 200 3P
HS /wkly
II 2x2x2/ 2wks
16/7/’15 >++ >++ Lt+3>Rt+2 Rt++=Lt+ BP:130/80mmHg OAN 30 3P HS/wkly
+ SILICEA 200 3P HS
II 2x2x2/ 1wk
23/7/’15 S.Q. >+ S.Q. Rt++=Lt+ RHUS TOX 200/TDS
+ Ii 2x2x2
SL 3P HS/ 1wk
13/7/’17 >++ >+ S.Q. Rt+=Lt+ BP:150/90mmHg OAN 200 1P
redness P: 80/min HS/wkly
SILICEA 200 3P HS/
wkly
SL TDS/ 4wks
9/8/’17 >+10% >++ S.Q. >++ RHUS TOX 1M TDS/
7 days
PT 1x1x1/7 days
Ii 3P HS/7 days
17/8/’17 S.Q. >++ >+ >++ THUJA 200 1P HS
SILICEA 200 3P HS
SL TDS/ 4wks
19/9/’17 S.Q. S.Q. Rt+=Lt+ Lt side BP:138/90mmHg THUJA 200 3P
T&N HS /wkly
SILICEA 200 3P
HS /Wkly
Ii 2x2x2/ 4 wks
14/10/’1 >+10% S.Q. S.Q. 0 THUJA 200 3P
7 HS /wkly
SILICEA 200 3P HS
SL TDS/ 4wks
13/11/’1 >+ >+ >+ 0 THUJA 200 3P
7 HS /wkly
(R) SILICEA 200 3P HS
SL TDS/ 4wks
11/2/’17 >+ >+ >+ 0 SILICEA 200 3P HS

70
 (R) SL 3 pills TDS/ 1wks
22/12/’1 >++ >++ >++ 0 SILICEA 200 3P HS
7 SL 3 pills TDS/ 1wks
11/1/’18 S.Q. S.Q. >++ Both SILICEA 200 3pills
Pain increase since 2 days daily/ HS
Ii 3 pills TDS/ 2wks

CONCLUSION:

 After receiving mental & physical characteristic symptoms of patient, we reached to

constitutional remedy as SILICEA
 In this case susceptibility is low to moderate according to age, sex, seat of disease and pace
of disease.
 1st follow up patient feel better in knee stiffness+, swelling + but not relief in knee pain &
crepitation
 THUJA given as miasmatic remedy for remove a miasmatic block in a moderate potency with
infrequent repetition
 Susceptibility is low to moderate according to age, sex, seat of disease and pace of disease.
 Increase the potency, after that pt feel much better in knee pain, swelling
 In acute exacerbation of disease RHUS TOX given as a acute remedy.
 SILICEA was choose as CR and also its effect on bony tissue so that it can help to pt to
improve bone strength

CASE NO: 08. PHYSICIAN: DR.AMI

D.O.C.: 2/11/’17 DEFINED NO: D: 10119
NAME: R.A.M. AGE: 61 year SEX: Male
EDUCATION: F.Y. B.com OCCUPATION: Farming

71
STATUS: Married RELIGIOUS: Muslim
VEG/NON-VEG: All SIS: 5 BR: 4
SON: 2 DAUGHTER: 1
ADDRESS: BHOJ. TA: PADRA

CHIEF COMPLAIN:
LOCATION SENSATION MODALITY CONCOMITTENTS
MSS
Extremities Pain+3 <+3 walking
Lower limb No crepitation <+2climbing stairs
Both knee joint <+2standing
Rt>Lt >+2 Rest
O: 15 yrs >+2 pressure
D: ½ hour >+2 hot fermentation
F: Daily >+2 Allo. Rx

ASSOCIATED COMPLAINTS:
Location Sensation Modality Concomitant
1.MSS Pain+= pulsating >+2 pressure
lower limb
Calf muscle

2.GIT Burning <+3 fried food

Stomach Sour eructation <+2 spicy food
O: 4 to 5 year <Tea
D: ½ hour >Drinking water
F: according to >Allo. Rx
modality

PHYSICAL GENERAL:
APPEARANCE: wheatish complexion, obese
Perspiration: scalp++, profuse
APPETITE: Normal
THIRST: Normal
CRAVINGS: Bananas++, Sweet++, Apple++, Chicken++
AVERSION: Sour++
STOOL: Normal URINE: Normal
Sleep: Deep
Dreams: Daily routine
THERMAL: C3H2

72
 WINTER SUMMER MONSOON
FAN 0 3 2
COVER Blanket Chadar chadar
BATH Warm Warm warm

PAST HISTORY: NIl

FAMILY HISTORY: Father: renal stone, Mother: paralysis

PHYSICAL EXAMINATION:
Weight: 96 kg Temp: AF Pulse: 74/min Tongue: Pink Conjunctiva: Pink
BP: 130/90mmHg

SYSTMIC EXAMINATION:
MSS: Knee joint
Joint Left Right
Crepitation + ++
SLRT Normal 70 ͦ pain start
Pain + ++
Warm 0 ++

PROVISIONAL DIAGNOSIS:
Severe bilateral OA knee

INVESTIGATION:
RADIOLOGICAL: X RAY: Narrowing of medial spaces with tibial spiking is seen.
S/O severe bilateral OA
Bone density appear normal
No focal lesion is seen.

LIFE SPACE:
Patient come in OPD with complain of knee joint pain.
CHILDHOOD: pt born in BHOJ. At that time family consist of Fa, Mo, Bro, Gfa, Sis. Pt has 4
brothers & 5 sisters. Pt has good IPR with them. Pt father was farmer. He was cool & calm by
nature. Mother is housewife. She is also cool & calm by nature. His financial condition was
medium. At that time all desire not full fill.pt feel “BHADHA PASE 6 MARI PASE NATHI”. He
never became obstinate.
SCHOOL LIFE: pt study till F.Y. B.com. His memory was sharp. He failed 3 times in F.Y.
because of difficulty in up down & at that time father expire. So, He was left the study. Good
IPR with his school friends. Pt also interest in school activity. He takes a part in activity and
play in state level.

73
 MARRIAGE LIFE: pt got married in 1978. Pt lived in join family. There are 58 family members
in family. Good IPR with his wife. Pt has good IPR with all family members. Pt work in farm.
Pt has 2 sons & 1 daughter. 5 year ago they separated to family each other because of his
family was large.
PATIENT AS A PERSON: pt is cool & calm by nature but sometime he became angry. In anger,
pt is spoken out. He became anxious when his father was expired. He is helpful in nature. Pt
is like to be alone but during work he like company. Pt more attached with son.

TOTALITY:
 Sentimental++
 Responsible+3
 Anger++: spoken out
 Sorrow++: weeping
 Self confidence++
 Helpful++
 Leadership
 Attached: With Children
 Fear: Water++
 Memory: Sharp
 Work: Perfect
 Dream: daily routine
 Perspiration: profuse+3, scalp++
 Craving: sweet+3, apple++,chicken+2,banana+2
 Aversion: sour++
 Chilly patient

REPERTORISATION:
 Mind – responsibility - seriously
 Mind - sentimental
 Mind – weeping - sorrow
 Mind - fastidious
 Mind - confident
 Mind – memory - active
 Mind – anger - spoken to when
 Mind – fear - water
 Mind - attached - children
 Mind - anxiety - anticipatory
 Perspiration - profuse
 Perspiration - face head
 Dreams - event daily
 General - food & drink – sweet - desire

74
 General - food & drink - apple - desire
 General - food & drink - chicken - desire
 General - food & drink - banana - desire
 General - food & drink – sour - aversion
 Chilly patient

REPERTORIAL RESULT:
SULPH: 16/11 SILI: 13/7
N.M.: 16/10 K.P.:12/9
LYCO: 17/10 N.V.:13/10
PHOS: 16/9 PULS: 14/9

REASON OF SELECTION OF THE REMEDY: Fastidious

Responsible
Anxiety: About Family
Perfectionist
Craving: Sweet++
Perspiration: Profuse
Chilly Patient

PLANNING AND PROGRAMMING:

DEFINE WITH REASONS THE STATE POTENCY-CHOICE REPETITION
1.SUSCEPTIBILITY Low
Age- 61 year 30 Infrequent
Sex- Male
seat of disease- structural irreversible
pace of disease- gradual
2. SENSITIVITY( MIND & NERVES)
Mind ++ 30 Infrequent
Nerves+
3. SUPPRESSIONS (IF ANY) -- --
No
4. CORRESPONDANCE (DEGREE & LEVEL) CONST. Rx
Mind+, Body++ SILICEA 30 Infrequent
5. CORRESPONDANCE (DEGREE & LEVEL) SECTOR Rx --
--
6. CORRESPONDANCE (DEGREE & LEVEL) INTER-CURRENT Rx --
--
7. FUNCTIONAL CHANGES
Present 30 Infrequent

75
 8. STRUCTURAL CHANGES 30 Infrequent
Irreversible
9. VARIATIONS( WITH TIME) -- --
10. GENERAL VITALITY
Good 30 Infrequent
11. PRESENTATION-
A. FUNDAMENTAL MIASM 30 Infrequent
SYPHILITIC
B. DOMINANT MIASM
SYCOTIC 30 Infrequent
C. SECTOR (ACUTE/EXACERBATION) -- --
D. RECENT GROUP (STATE FROM-----) -- --
E. CONFUSED -- --

FIRST PRESCRIPTION: SILICEA 30 2x2x2

SL 2x2x2/ 4wks

CRITERIA:
1. Knee Pain: Rt/Lt: I/F/D
2. Stomach Burning
3. Sour eructation
4. Calf Muscle Pain
5. O/E: Knee: Crepitation
6. BP, wt

FOLLOW UPS:
DATE 1 2 3 4 5 6 PRESCRIPTION
30/11/’1 >+ >++ >++ >+ Rt++/Lt+ Wt: 95 kg SILICEA 30 3x3x3
7 SL 3x3x3/ 4 wks
4/1/’18 >++ 0 0 >++ Rt+/Lt+ Bp:130/80mmHg SILICEA 30 3x3x3
50% Wt: 94 kg SL 3x3x3/ 4 wks

CONCLUSION:

 After case definition prescribe SILICEA as a constitutional remedy base of the mental &
physical symptoms.

76
 In susceptibility is low to moderate according to age, sex, seat of disease and pace of
disease.
 In 1st follow up patient complain better in both knee pain+, acidity++, calf muscle pain+. So
continue same treatment given
 In 2nd follow up patient better 50% in both knee pain++, acidity++, calf muscle pain++, but
present crepitation in knee joint
 SILICEA help in improving joint space so that bone functions improve.

77
CASE NO: 09. PHYSICIAN: DR.JDS
D.O.C.: 1/7/’15 DEFINED NO: D: 7051
NAME: S.R.P. AGE: 60 year SEX: Female
EDUCATION: 6th STD OCCUPATION: Housewife
STATUS: Married RELIGIOUS: Hindu
VEG/NON-VEG: Veg. SIS: 3 BR: 2
SON: 2 DAUGHTER: 1
ADDRESS: KARJAN

CHIEF COMPLAIN:
LOCATION SENSATION MODALITY ACCOMPANIMENTS
MSS
Both knee joint Pain++ <++ walking
Lt++/Rt+ Crepitation++Rt <++winter
O: 8 month Stiffness++ <++damp weather
Increase 6 month No swelling >++Allo.Rx
D:intermittent No warmth >++pressure
F: 2 times/15 day >++physiotherapy
>++warm water
application
Left knee pain++
Calf muscle No tingling <++movement of leg
O: 2 to 3 year No numbness <++walking
D:10 min Swelling++ >++Allo.Rx
F: On/Off

ASSOCIATED COMPLAINTS:
LOCATION SENSATION MODALITY ACCOMPANIMENTS
MSS
Both hands & Pain++ <++pressure
fingers Swelling++ <++pulses
O: 2 year Stiffness+ <++damp weather
D: intermittent Warmth++ >++Allo.Rx
F: On/Off Nerve pulling

PHYSICAL GENERAL:
APPEARANCE: wheatish complexion
Perspiration: Profuse, Back+, palm++, forehead+, upper lip+
APPETITE: Normal
THIRST: Normal
CRAVINGS: pickles++, spicy++

78
AVERSION: NAD
STOOL: Normal URINE: Normal
Sleep: Supine position
Dreams: NAD
MENSTURAL FUNCTION:
F.M.P.: 16 yrs MENOPAUSE: 45 yr
Menses: Regular Cycle: 1month Duration: 3 day
Color: Red Stains: No
THERMAL: C3H2
WINTER SUMMER MONSOON
FAN 1 5 2
COVER Rajai chadar chadar
BATH Hot Tepid Hot

PAST HISTORY: NIL

FAMILY HISTORY: Father: breathlessness

PHYSICAL EXAMINATION:
Weight: 64 kg Temp: AF Pulse: 72/min Tongue: Pink Conjunctiva: Pink
BP: 140/90 mmHg

SYSTMIC EXAMINATION:
RS: Air entry: BLE
MSS: Crepitation: Lt++/Rt+

PROVISIONAL DIAGNOSIS:
Bilateral OA knee with RA

INVESTIGATION:
19/2/’15 ESR: 24
HB: 12.8 PLATELETS: 218000
RBC: 4.54. Uric acid: 5.59
PCV: 37.3 R.A.: 3.51
MCV: 82.2
MCH: 28.2
MCHC: 34.3

LIFE SPACE:
A 60 year old lady come in OPD with complain of pain in left & right knee. Enter with smiling
face. All question answer telling completely with detail.

79
 CHILDHOOD: she born and brought at BODKAR. In her family consist of mo, fa, 2 bro, 3 sis.
Good IPR with all family members. Her father was work as a farmer. His nature is cool &
calm. Her mother was occasionally irritable if house work not done. His father has a 20 vigha
land & 2 buffalo that time her financial condition not good. Even difficult in manage in daily
food.
SCHOOL LIFE: She was study up to 6th STD. Pt average in study. She has more interest in
house activity. She participated in “LANGDI”, Rope Jumping in school. She not study because
of walking of BODKAR to karjan. So, Pt not study. Good IPR with teacher & friends.
MARRIAGE LIFE: She married in 12 to 13 year of age. In her family member consist of FIL,
MIL, 2 BIL & 2 SIL, 1 SIL. 1st BIL was mentally ill. He died after pt marriage & 2nd BIL stay in
joint family. 50 vigha land all handling done her BIL. Her husband nature is cool & calm. If
more work then tired that time pt irritable on her husband. Pt has 2 sons. 1 st son completed
pharmacy. 2nd son studied electrical & 1 daughter in B.com. When her son decide medical
store start that time pt husband demand money but her BIL’S son given loan pepar & telling
all money pay by her son & her husband & cheat also in property. When separate that time
pt feel “KEVI RITE GHAR NU HANDLING THASE AMARI JODE KEM AAVU KRYU”. But after hurt
pt handle all things. Her elder son is married. Good IPR with his wife’s nature. Her younger
son also married. His wife work in own beauty parlar. Younger son do a love marriage. She is
patel community. After that her younger son takes a divorce. This incidence after pt became
tension” MARA 6OKRA NU SHU THASE! TENE KON KHAVDAVSE” & also his elder son told her
Mother” TE KAI KAMATO NATHI” that time feels tension about that.
PATIENT AS A PERSON: Pt is irritable in nature when work not done properly. She anxious
about her younger son’s marriage life. She is sentiment in nature. She is suppressed the
anger then cry. She gives food & money in poor people. Cry when scolded anybody. Can’t
tolerate sadness.

TOTALITY:
 Responsible
 Irritable: When Not Work In Proper Time
 Perfectionist
 Anger: Suppressed
 weeping: After Anger
 Helping Nature
 Sentimental
 Fear: Height++
 Perspiration: Profuse+, Back+, Palm++, Forehead+, Upper Lip+
 Craving: Pungent++, Pickles++
 Sleep: Supine Position
 Chilly Patient

REPERTORISATION:

80
 Mind - anger - suppressed
 Mind – irritability - working, when
 Mind - responsibility, taking responsibility
 Mind - helping nature
 Mind – fear - high places
 Mind - perfectionist
 Mind - sentimental
 Mind – weeping - anger after
 Face - perspiration - forehead
 Face – perspiration - lips - upper
 Back - perspiration
 Perspiration - profuse
 Extremities – perspiration – hand - palm
 Sleep – position - back, on only back
 Generals - food & drinks – pickles - desire
 Generals - food & drinks – pungent - desire
 Chilly patient

REPERTORIAL RESULT:
N.V.:17/9 SILIC: 12/7
SULPH: 16/9 PULS: 12/6
N.M.: 13/8 SEP: 15/7
PHOS: 12/7 K.P.:10/6

REASON OF SELECTION OF REMEDY:

Responsible
Perfectionist
Sentimental
Perspiration: Back, Palm++, Profuse
Fear: High Place
Chilly patient

PLANNING AND PROGRAMMING:

DEFINE WITH REASONS THE STATE POTENCY-CHOICE REPETITION
1.SUSCEPTIBILITY Low
Age- 60 year
Sex- female
seat of disease-structural irreversible 30 Infrequent
pace of disease- gradual
2. SENSITIVITY( MIND & NERVES)
Mind++ 30 Infrequent

81
 Nerves++
3. SUPPRESSIONS (IF ANY)SSS -- --
No
4. CORRESPONDANCE (DEGREE & LEVEL) CONST. Rx
Mental+, physical SILICEA Infrequent
5. CORRESPONDANCE (DEGREE & LEVEL) SECTOR Rx --
--
6. CORRESPONDANCE (DEGREE & LEVEL) INTER-CURRENT Rx Infrequent
THUJA 1M
7. FUNCTIONAL CHANGES Infrequent
Present 30
8. STRUCTURAL CHANGES 30 Infrequent
Irreversible
9. VARIATIONS( WITH TIME) -- --
10. GENERAL VITALITY
Good
11. PRESENTATION-
A. FUNDAMENTAL MIASM 30 Infrequent
PSORA
B. DOMINANT MIASM 30 Infrequent
SYCOTIC
C. SECTOR (ACUTE/EXACERBATION) RHUS TOX Infrequent
D. RECENT GROUP (STATE FROM-----) -- --
E. CONFUSED -- --

FIRST PRESCRIPTION: RHUS TOX 200 QDS/ 3 days

PT 1x1x1 / 7 days
SL 3x3x3/ 7 days

CRITERIA:
1. Knee pain: Rt/Lt
2. Calf muscle pain
3. Both hand finger pain
4. O/E: crepitaion
5. Bp, wt

FOLLOW UPS:
DATE 1 2 3 4 5 PRESCRIPTION
8/4/’15 Rt=0,Lt=>80 >+ >+ Not done BP:110/70mmHg RHUS TOX 200 TDS/
% 3 days
PT 1x0x0,SL 3x3x3/

82
 7 days /2wks
22/4/’15 >++ >+ >+ Not done Wt:63 kg SILICEA 30 3P HS
SL 3x3x3,PT 1x0x0/7
days/ 2wks
6/5/’15 >++ >++ >+ Not done Wt: 63kg SILICEA 30 3P HS
BP:110/70mmHg SL 3x3x3,PT 1x0x0/7
days/ 2wks
3/6/’15 <+:since14 >++ >+ Note Wt:63 kg RHUS TOX 200 TDS/
days done 3days
PT 1x0x1,SL 3x3x3/
7 days/ 1st wk
SILICEA 30 3P HS
SL 3x3x3,PT 1x0x1/7
days/ 2nd wks
17/6/’16 >++ 0 0 Not done RHUS TOX 200 TDS/
3days
PT 1x0x1,SL 3x3x3/
7 days/ 1st wk
SILICEA 30 3P HS
SL 3x3x3,PT 1x0x1/7
days/ 2nd,3rd & 4th
wks
22/7/’15 0 0 0 NAD BP:110/80mmHg SILICEA 30 3P HS
SL 3x3x3, PT 1x0x1/
7days/ 4th wk
21/10/’16 >+ 0 S.Q. Rt++/Lt++ RHUS TOX 200
QDS /4 days
PT 1x1x1x1/4 day
SILICEA 30 3P Hs
SL 3x3x3, PT
1x0x1 /4 wks
23/12/’16 >++ 0 >+ Rt+/Lt+ BP:160/84mmHg SILICEA 200 3P HS
SL 3x3x3
PT 1x0x1/ 4wks
27/1/’18 Rt>+/Lt>++ >++ >+ Rt+/Lt+ BP:140/80mmHg RHUS TOX 200
TDS /7 days
PT 1x1x1/7 day
SL 3P HS/1st wk
THUJA 1000 1P HS
SILICEA 200 6P Hs
SL 3x3x3, PT

83
 1x0x1 /2nd wk
3/3/’17 >++ >++ >++ NAD BP:140/70mmHg THUJA 1M 1P HS
SILICEA 200 6P HS
SL 3x3x3, PT 1x0x1/
4wk
26/5/’17 >++ >++ >++ NAD THUJA 1M 1P HS
SILICEA 200 6P HS
SL 3x3x3, PT 1x0x1/
4wk
23/6/’17 >++ >++ >++ NAD THUJA 1M 1P HS
SILICEA 200 6P HS
SL 3x3x3, PT 1x0x1/
4wk
11/8/’17 <+ S.Q. S.Q. Rt+/Lt+ BP:120/80mmHg THUJA 1M 1P HS
SILICEA 200 6P HS
SL 3x3x3, PT 1x0x1/
2wk
15/9/’17 >++60% >++ >++ NAD BP:130/90mmHg THUJA 1M 1P HS
SILICEA 200 6P HS
SL 3x3x3, PT 1x0x1/
4wk
13/11/’17 >++ >++ >++ NOT THUJA 1M 1P HS
DONE SILICEA 200 6P HS
SL 3x3x3, PT 1x0x1/
4wk
8/12/’17 0 0 0 NOT BP:160/90mmHg THUJA 1M 1P
DONE HS/once per 2 wks
SILICEA 200 6P HS
SL TDS/ 4wk
2/2/’18 0 0 0 NOT THUJA 1M 1P HS
DONE SILICEA 200 6P HS
SL 3x3x3/ 4wk

CONCLUSION:

84
 In this case first prescription is RHUS TOX 200 3 pills QDS for 3 days as acute remedy.
 Then patient got so much better in knee pain then same prescription given.
 Then physician prescribed SILICEA (CR) base on mental & physical symptoms in 30 3P HS for
2 weeks.
 After that patient feel better in 50% both knee pain++, calf pain++, hand finger ++ but
crepitation present in knee joint
 After 4th follow up patient aggravated because of acute exacerbation of the disease so
prescribed RHUS TOX as a acute remedy.
 After given THUJA 1M because of subsequent follow up patient not feel better well so also
possibility of miasmatic block, from this aspect given THUJA as a intercurrent remedy.
 After give intercurrent remedy patient feel better almost better in both knee pain+, calf pain
+& crepitation+
 Now patient feel all over better in both knee joint pain and no any complain.
 SILICEA was choose as CR and also its effect on bony tissue so that it can help to pt to
improve bone strength

CASE NO: 10. PHYSICIAN: Dr. AKSHAY PATEL

D.O.C.: 27/10/’17 DEFINED NO: D: 10091

85
NAME: P.P.G. AGE: 72 year SEX: Female
EDUCATION: 11th S.S.C. OCCUPATION: House wife
STATUS: Widow RELIGIOUS: Koli patel
VEG/NON-VEG: Veg. SIS: 5 BR: 2
SON: 1 DAUGHTER: 3
ADDRESS: ANKLESHWAR

CHIEF COMPLAIN:
LOCATION SENSATION MODALITY CONCOMITTENTS
MSS
Extremities Throbbing pain++ <++cloudy weather
Both knee joint Stiffness+ <++walking
Rt>Lt <++standing from
O: 30 yrs. sitting
D: 5 to 6 month <++ pressure
F: on/off >++ warm
application

Both ankle joint Swelling++ A/F: dislocation of

Both shoulder joint shoulder joint due
Rt>Lt to fall down
O: 2 to 3 yr. <++ cold
D: 6 month atmosphere
F: on/off <++sour food
>++oil massage
>++Allo. Rx

ASSOCIATED COMPLAINTS:
Location Sensation Modality Concomitant
GIT
Rectum Stool= hard >+ CHURAN
Constipation No odour
O: 5 to 6 year

Anus Piles
O: 2 to 4 years Pain++
Bleeding+

PHYSICAL GENERAL:
APPEARANCE: wheatish complexion, medium built

86
PERSPIRATION: profuse+, dribbling. Partial: chest++, Hand++, face++
APPETITE: Normal
THIRST: Normal
CRAVINGS: sweets++, curd++, pungent++
AVERSION: Milk+
STOOL: constipation, hard URINE: Normal
Sleep: disturbed: noise & light

MENSTURAL FUNCTION:
F.M.P.: 8th std Menopause: 15 to 20 year
Menses: regular Cycle: 30 days Duration: 3 days
Color: Red
Concomitants: B.M: Lower abdominal pain
THERMAL: C4H
WINTER SUMMER MONSOON
FAN 0 4 0
COVER Blanket 0 Blanket
BATH Hot Hot Hot

PAST HISTORY: Tubal ligation, cataract

FAMILY HISTORY: Mother: breathlessness

PHYSICAL EXAMINATION:
Weight: 60kg Temp: AF Pulse: 76/min Tongue: Pink Conjunctiva: Pink
BP: 180/90mmHg

SYSTMIC EXAMINATION:
MSS:
Knee Right Left
Swelling NAD NAD
Redness NAD NAD
Crepitation ++ ++
Tenderness +++ ++
ROM Restricted Normal

INVESTIGATION:
2/10/’17 9/2/’17 2/10/’17 9/2/’17
HB 8.40 7.5 WBC 7100 3500
RBC 3.97 3.80 N 60 60
PCV 26.10 L 34 38
MCV 65.74 65.8 E 03 03

87
 MCH s21.16 19.7 M 03 02
MCHC 32.18 30.0 B 00 00
CPK 29.0 platelets 86000 144000

RBS: 86mg%
RADIOLOGICAL: X - ray: Severe OA
Arthritis profile: 7/10/’17
RA: negative
Anti streptolysin ‘o’ titre: negative
CPR: negative

PROVISIONAL DIAGNOSIS:
Bilateral Severe OA knee

LIFE SPACE:
A 72 yr old age lady came in OPD with complain of joint pain.
CHILDHOOD: Pt born in saholi village that time pt lived with Fa, Mo, 5 sis and 2 bro.
Grandparents both expired. Father‘s nature cool & calm in nature. He is farming work in 30
vigha land. Mother was cool & calm by nature. She was housewife. Patient has good IPR
with all family members. Her financial condition was good. All demand fulfilled at that time.
SCHOOL LIFE: She was study std till 11thstd. Pt is good in study. She was started study at vapi
but her father did not allow her. She has regret also about that.
After that she left the study & she joined to the house work & help to her mother. ”KAM KRI
KRI NE HADKA GHASAI GYA.” she also participated in school activity like limbu chamchi,
garba, kho kho, etc. She wants to become teacher.
MARRIAGE LIFE: Pt got marriage at age of 22 yr at ashodh. Her marriage was arranged by her
parents. Pt’s in family consist MIL, FIL, 3BIL, STL & husband. FIL denied for PTC, salary was 15
RS. FIL was not able to give fees of pt’s hus. So, pt’s father gave money for husbnd’s PTC. But
not give for pt. pt wanted to be teacher. FIL had give money for SIL’s study. Financial
condition was poor than father’s home. Good IPR with her SIL, MIL, BIL, FIL. After marriage,
they got separated happily each other.
Now, all BIL are expired .pt have good IPR with co sis. Pt SIL was expired after delivery on
this incidence. Pt said that”AEKLA PADI GYA, SANGHATH 6UTI GYO. After death of SIL, her
son was live with pt & her daughter was live with his father. SIL’s son grown up by pt. he
says pt as a mom. Patient has 1 son & 3 daughters. Pt’s son is married and lived at
ankleshwer because of job. Pt having good IPR with her DIL. Pt’s live with her younger
daughter because of her divorcing. Daughter’s MIL IPR not good. “TRAS BHAHU APE 6”.
Patient’s husband was died because of MI while returning from paralysis; kidney failure.pt
was with him while death occurs. Pt receives pension 1200rs. Father was expired 5 month
after of husband’s death.
All responsibility was come on pt. brother quarrel for properties so they gave it.

88
 PATIENT AS A PERSON: Patient is cool & calm nature. Pt has taken all responsibility of family.
She is anxious about of her daughter’s marriage life & her future. Pt is sentiment in nature.
Pt does not like to fight with anyone. Patient wants everything neat & clean.

TOTALITY:
 Cool & Calm
 Desire: Company
 Responsible
 Anxiety: About Daughter, Future
 Sentimental
 Fastidious
 Aversion: Quarrel
 Perspiration: Profuse++,Dribbling, Chest++, Hand++, Face++
 Craving: Sweets++, Curd++, Pungent++
 Aversion: Milk+
 Sleep: Disturbed By Noise & Light
 Chilly Patient

REPERTORISATION:
 Mind - Tranquility
 Mind – Anxiety - Future, About
 Mind - Fastidious
 Mind - Quarrelling - Aversion
 Mind - Responsibility, Take To
 Mind - Sentimental
 Face - Perspiration
 Chest - Perspiration
 Perspiration - Profuse
 Extremities – Perspiration - Hand
 Sleep – Disturbed - Noise, By Slightest
 Generals - Food & Drinks – Curd - Desire
 Generals - Food & Drinks – Pungent - Desire
 Generals - Food & Drinks – Sweet - Desire
 Generals - Food & Drinks – Milk - Aversion
 Chilly Patient

REPERTORIAL RESULT:
PHOS: 28/14 PULS: 21/13
SEP: 27/14 LYC: 22/12
N.M. 22/14 SIL: 18/10
SULPH: 25/13 CALC: 24/11

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REASON OF SELECTION OF REMEDY: Cool & Calm
Anxiety: About Future
Desire: Company
Fastidious
Perspiration: Profuse, Face, Chest, Hand
Craving: Sweets+
Aversion: Milk+
Chilly Patient

PLANNING AND PROGRAMMING:

DEFINE WITH REASONS THE STATE POTENCY-CHOICE REPETITION
1.SUSCEPTIBILITY : Low
Age- 72 yr 30
Sex- female Infrequent
seat of disease- structure Irreversible
pace of disease- slow
2. SENSITIVITY( MIND & NERVES)
Mind+ 30 Infrequent
Nerves++
3. SUPPRESSIONS (IF ANY) -- --
No
4. CORRESPONDANCE (DEGREE & LEVEL) CONST. Rx
Mental++ , physical+ Infrequent
SILICEA 30
5. CORRESPONDANCE (DEGREE & LEVEL) SECTOR Rx --
--
6. CORRESPONDANCE (DEGREE & LEVEL) INTER-CURRENT Rx Infrequent
THUJA 200
7. FUNCTIONAL CHANGES
Present 200 Infrequent
8. STRUCTURAL CHANGES
Irreversible Low 30 Frequent
9. VARIATIONS( WITH TIME) -- --
10. GENERAL VITALITY
Low 30 Frequent
11. PRESENTATION-
A. FUNDAMENTAL MIASM 200 Infrequent
PSORA
B. DOMINANT MIASM
SYCOTIC 30 Frequent

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 C. SECTOR (ACUTE/EXACERBATION) -- --
D. RECENT GROUP (STATE FROM-----) -- --
E. CONFUSED -- --

FIRST PRESCRIPTION: SL 1P HS
SL TDS/ 1wk

CRITERIA:
1. Both knee pain
2. Both ankle pain
3. Both shoulder pain
4. Stiffness
5. Piles pain
6. Constipation
7. O/E: crepitation, swelling, BP

FOLLOW UPS:
DATE 1 2 3 4 5 67 PRESCRIPTION
3/11/’17 S.Q. S.Q. S.Q. S.Q. S.Q. S.Q.
Bp:120/80mmHg SILICEA 30 3P HS
SL PILLS TDS/ 6wks
2/12/’17 >+5% >+ >+ >+ >+ >+ NOT DONE THUJA 200 1P /2 wkly
(R) SILICEA 30 6P HS
SL pills TDS/ 4 wks
12/1/’18 >++ >++ >++ S.Q. >+ >+ Crepi. = Rt+/Lt+ THUJA 200 1P HS
SILICEA 30 TDS/ 4 wks
8/2/’18 >+ >+ >+ >+ >+ >++ Crepi.=0 THUJA 1M 1P once/
2wk
SILICEA 200 1P HS
SL TDS/4 wks
30/3/’18 S.Q. S.Q. S.Q. S.Q. S.Q S.Q. NOT DONE THUJA 1M 1P HS
(R) once/2 wk
SIL 200 1P HS
CAL Floor 6x 3x3x3
SL TDS/ 6 wks
8/6/’18 >++ >++ >++ >++ >+ S.Q. NAD THUJA 1M 1P HS
Piles pain= 2 to 4 days , Burning++, bleeding++ once/ 1wk
<++spicy food, sitting, >++ cold AESCULNS HIP 200
QDS 3 pills/ 3 days
SL TDS/1 wk
15/6/’18 >++ >++ >++ >++ >++ >+ NAD THUJA 1M 1P HS
once/ 2 wks

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 SILICEA 200 1P HS
SL 3x3x3 TDS/ 4wks

CONCLUSION:

 First prescription given SL 1P HS so, patient not feel better in knee pain or all complain.
 After patient came 1st follow up patient not better, then give SILICEA (CR) remedy in low
potency
 Susceptibility is low to moderate according to age, sex, seat of disease, Pace of disease.
 In next follow up patient complain better only 5% in knee joint pain so also one possibility of
miasmatic block, from this aspect given THUJA as a intercurrent remedy.
 Then after patient feel better 50% in knee pain++, ankle pain++, shoulder pain++, knee
stiffness++, piles & constipation+.
 Also need acute remedy according to acute complain
 SILICEA help in improving joint space so that bone functions improve.
 Increase potency after that patient get result better in both knee pain++, shoulder pain+,
knee stiffness+, no crepitation.
 In 6th follow up patient feels better in knee pain++, ankle pain++, shoulder pain++, no
swelling & no crepitation

FINAL CONCLUSION

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 In 10 cases of Osteoarthritis my final conclusion is require SILICEA remedy for treatment of
OA knee, it is not only treat OA but also treat other complain & symptoms like mental as
well as physical.
 All Patients feel better in both knee joint pain, stiffness, swelling, crepitation after given
SILICEA as a constitutional remedy.
 SILICEA help in improving joint space so that bone functions improve.
 SILICEA was choosing as CR and also its effect on bony tissue so that it can help to pt to
improve bone strength.
 From the study of 10 cases I conclude that majority of cases get relieved with the help of
SILICEA as a constitutional remedy with intercurrent remedy, but some cases may require
only constitutional remedy for complete cure.
 Mostly SILICEA given in 30 or in 200 potencies, on basis of susceptibility and sensitivity of
patient.
 3rd, 7th, 9th & 10th cases were given intercurrent as a THUJA for anti miasmatic remedy, it
required for a removing the miasmatic block of patient.
 Looking to gender in my cases 6 cases of female and 4 cases of male.
 SILICEA act well in all 10 cases and give a good result.
 This assignment proves that homoeopathy have wonderful role in treatment of
homoeopathic chronic cases.

SUMMARY

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 I was eager to explore the role of SILICEA in OA. I studied various books and collected the
information regarding to SILICEA in MSS actions. Then I analyzed 10 cases.
 I experienced that after the giving the SILICEA remedy it affect on knee joint and gives us
satisfied result which we want as a homoeopathic medicine.
 In 10 cases I understood that SILICEA is a deep acting constitutional remedy is best for
treatment of OA rather than therapeutic remedy.
 More affected age group is 45 to 70 yr of the age.
 From 10 cases 6 female and 4 male are affected.
 From 10 cases all are better by constitutional remedy.
 4 cases require THUJA as intercurrent remedy.
 2 cases require RHUS TOX remedy as a acute exacerbation of disease.
 Homoeopathic mode of treatment is well affected in the management of OA.

BIBLIOGRAPHY

ANATOMY & PHYSIOLOGY:

94
 1. GERARD J. TORTORA, BRYAN DERRICKSON
2. B.D.CHORASIYA

MEDICINE BOOKS:
1. DAVIDSON’S - PRINCIPLE’S & PRACTICE OF MEDICINE: 20th Edition, Edited by NICHOLAS A.
BOO, NICKI R., BRIAN R. WALKER, International Editor – JOH`N A.A. HUNTER.
2. API Textbook of Medicine - 8 thEdition,VOLUME – II, Editor in chief – SIDDHARTH N. SHAH,
Executive Editor – M. PAULANAND
3. HARRISON’S – PRINCIPLES OF INTERNALMEDICINE – 17th Edition. Editor – FAUCI ®
BRAUNWALD ® KASPER ® HAUSER ® LONGO ® JAMESON® LOSCALZO, VOLLUME – 2.
4. ESSENTIAL ORTHOPAEDICS by J.Maheshwari
Textbook of ORTHOPEDIC by john Ebnezar

ORGANON:
1. HAHNEMANN’S ORGANON OF MEDICINE, B.K. SARKAR, APHORISM 5(page no.116).
2. PRINCIPLES & PRACTICE OF HOMOEOPATHY, Dr. M.L. Dhawale – M.D. (BOM), Part – I,
concept of constitutional remedy, role of constitutional remedy
3. Supplementary to A Treatise on Organon of Medicine, Part – I (page no. 47, 48) factors of
constitutional, constitutional medicine, by Prof. Ashok Kumar Das – Gold Medalist

MATERIA MEDICA:
1. LECTURES ON HOMOEOPATHIC MATERIA MEDICA TOGETHER WITH KENT’S “NEW REMEDIES
“ INCORPORATED AND ARRANGED IN ONE ALPHABETICAL ORDER – James Tyler Kent
2. BOERICKE’S NEW MANUAL OF HOMOEOPATHIC MATERIA MEDICA WITH REPERTORY Third
Revised & Augmented Edition, Based on Ninth Edition, WILLIUM BOERICKE
3. MATERIA MEDICA PURA , HAHNEMANN
4. ENCYCLOPEDIA OF MATERIA MEDICA, T.F.ALLEN

REPERTORY:
1. REPERTORY OF THE HOMOEOPATHIC MATERIA MEDICA – J.T.KENT
2. REPERTORIUM HOMOEOPATHICUM SYNTHETICUM Edited by Dr. Frederikschroyens Edition
– 9.13.RADAR

MASTER TABLE

CASE DEFINE NAME AGE SE DIAGNOSIS SUSCEPTI A CR IR

95
NO NO X BILITY R
1 10010 SJR 27 M MILD OA MODERA SILICEA
TE
2 11216 PHI 45 F OA+HTN LOW SILICEA

3 6698 PAY 50 F OA+HTN MODERA SILICEA THUJA

TE
4 4214 HKB 47 F OA+HTN LOW SILICEA

5 10280 PGI 70 M MODERAT LOW SILICEA

E OA
6 11211 MAM 50 M MILD OA LOW SILICEA

7 7075 SSR 72 F OA LOW RT SILICEA THUJA

8 10119 RAM 61 M SEVERE OA LOW SILICEA

9 7051 SRP 60 F OA+RA LOW RT SILICEA THUJA

10 10091 PPG 72 F SEVERE OA LOW SILICEA THUJA

96