ABSTRACT: In a case of fever, patient came with fever which begins with chills followed by heat and then sweating for 2-3 days. In Sensation it is burning inside, feels partially heat in head. Modalities include < morning> by rest & sleep. Concomitants having nausea & vomiting, constipation with hard & unsatisfactory stool during fever associated with generalized weakness body ache. In personal history patient is chilly, aversion to food and drink with bitter taste in mouth. Perspiration is partially upon back. So in this case of fever considering BBCR, remedy selected Nux Vomica. This case shows the effectiveness of BBCR contains the concept of LSMC with complete symptoms (totality), pathological generals, aggravation & amelioration in general. In concomitants symptoms like nausea, vomiting, body ache, constipation, taste alterations, perspirations (scanty or profuse), weakness along with thermals etc, as it having important role to select the simillimum.

Key words: Fever, Homoeopathy, Nux Vomica, BBCR.

Introduction: In today’s scenario, it is very common that fever is a symptom of disease rather than a disease. So to cure any of the disease it is very essential to know the causes, various patterns, types, and grade of the fever. Fever which is also known as pyrexia, it is a process of temperature is increased in body over homoeostasis conditions and hypothalamus regulates the body temperature. The severity of fever is decided as Low grade fever in between: 100^o F – 102.5^o F, Moderate fever in between: 102.5^o F – 104.5^o F & High grade fever in between: 104.5. of – 106.5^o F. ^[1]

PYROGENS:

Pyrogen is substances which causes fever.

Exogenous pyrogens are from outside the patient and mostly are toxins of microbes or microorganisms as a whole. E.g., lipopolysaccharide, endotoxin produced by all gram-negative bacterias. Gram-positive organisms having enterotoxins of Staphylococcus aureus and streptococcal toxins of A and B group are called super antigens. The toxins of Staphylococcus are associated with S. aureus isolates from patients with toxic shock. These products of staphylococci and streptococci cause fever through experiments in animals when injected at concentrations of 1– 10 μg /kg intravenously.

In humans Endotoxinis in high Pyrogenic molecule, which is injected intravenously into volunteers, fever and generalized symptoms of malaise arises in a dose of 2–3 μg/kg. ^[2]

HOMOEOPATHIC ASPECT

As like many stalwarts in Homoeopathy, all have given their views regarding curing various diseases by utilizing their philosophical background. But, among them, Dr. Boger Boenninghausen’s characteristics and Repertory (BBCR) by Dr. Cyrus. M. Boger is one of the greatest Homoeopathic literatures. Dr. Boger gave the idea of complete symptom, which is studied in relation to location, sensation, concomitant & modalities.

Dr. C. M. Boger, during his clinical practice he found huge number of cases of fevers especially pathological fever which inspires him to work more on fever by using the concept of Boenninghausen and gave a chapter on fever totality.

As like other chapters in BBCR, fever chapter is the contribution of Dr. Boger for the prevention of fever. Also, we can say that most of the fever is of infective etiology and to avoid infection good hygienic condition should be maintained, along with avoid the contact of sick people. Fever chapter in BBCR is extremely rich in concomitant accompanied by chill, heat & sweat. By forming the fever totality and with the help of repertorization, considering concomitant symptoms for selection of simillimum. In Pathological fever, it indicates the cases without any characteristic expression to repertorize clinical/diagnostic rubrics. Blood and Circulation chapter is given in fever under the symptoms of congestion, palpitation, heartbeat, pulse which are significant in fever. In Blood, we can take types as acrid, offensive and clotted, associated with hemorrhagic conditions. In Circulation, we can take abnormalities of blood vessels associated with fever. Congestion includes congestion in various organs of the body with fever. In palpitation, it can be taken the general conditions affecting palpitation in body. Heart – beat, especially in heart troubles and pulse with abnormal & irregular pulse associated with fever is taken for repertorization, as reportorial result is given more importance by this order and proper potency is selected according to the susceptibility of the patient. In posological part like dosage and potency it can be decided by the severity of the fever in a case.^[2][3]

CAUSES:

Any infective etiology

-Viral

-Bacterial

-Environmental

-In some cases medicinal reaction

SYMPTOMS:

Increase in temperature than normal range
Chill / shivering
Sweating
Body ache
Loss of appetite & thirst
Generalize weakness

CASE: Name: Mr. XXX

Age/sex: 42 years / Male Marital status: Married

Occupation/education: Shopkeeper Diagnosis: C/o Fever

CHIEF COMPLAINTS:

- Patient came with fever that started with shivering & Chill followed by sweating.
- Fever with periodicity, < morning> sleep.
- Heat in head during fever& sweat on back.
- Nausea & vomiting along with fever.
- Constipation with hard stool with a sense of un satisfaction.
- Headache.
- Desire for sweet.
- Bitter taste with loss of appetite and loss of thirst since fever.
- Generalize weakness with desire to rest and sleep which gives sense of relief.
- Feeling of heat inside the body since 3 days

PERSONAL HISTORY:

Appetite: loss of appetite since fever Thirst: thirst less, approx. 5 – 6 glass / day Aversion: food aversion since fever Desire: Sweet

Stool: unsatisfactory, hard & constipated Urine: normal

Perspiration: especially on back Thermal: chilly patient

Sleep: wants to sleep during fever Dreams: not specific

Mind: Irritable, anger++

PAST HISTORY: Malaria

FAMILY HISTORY:

Father: Hypertension Mother: NAD

PHYSICAL EXAMINATION / VITALS:

Temperature: 101^o F Pulse: 110 bpm

Blood Pressure: 136/90 mm of Hg SPO2: 99 % SYSTEMIC:

CNS: N.A.D.

CVS: N.A.D.

RS: N.A.D. G.I.T.: N.A.D.

LAB. INVESTIGATIONS: Advised for: CBC, MP, CRP

RUBRICS:

- - Heat and fever in general – morning
  - Heat and fever – internal (sensation of)
  - Chill – shivering – shivering – in general
  - Heat and fever in general – partial heat – head on,
  - Heat and fever in general – Concomitants – nausea and vomiting
  - Heat and fever on general – Concomitants – stool – constipation
  - Heat and fever in general – Concomitants – head – pain, headache
  - Heat and fever in general – Concomitants – taste – taste – bitter
  - Heat and fever in general – Concomitants – appetite – repugnance – food
  - Sweat – partial sweat – partial sweat – on back
  - Compound Fevers – Beginning with chill – compound fevers, in general
  - Fever – Pathological types – intermittent and periodicity – 1 to 3 day

REPERTORIZATION CHART:

1. Nux Vomica : 13/36 2. China : 12/23

3. Sepia : 11/ 31

Pulsatilla : 11/24
Lycopodium : 9/22

PRESCRIPTION:

Rx,

Nux Vomica 30, 3 hourly,

Nux Vomica is selected on the basis of thermal as patient is chilly, hence other remedies were ruled out. Desire for sweet, Gastric disturbances and general constitution is with a highest mark.

Selection of potency is according to the susceptibility of the patient. Dosage and repetitions are as per the case severity.

DIET & REGIMEN: Advised for green leafy vegetables, seasonal fruits, coconut water & plenty of fluids with proper rest.

Follow up	Symptoms	Treatment
10/12/2022	Improvement in fever, nausea & vomiting decreased with relief in body ache. Temp: 100^o F, pulse: 96 bpm, BP: 130/86 mm of Hg	Rx, Nux Vomica 30 T.D.S.
11/12/2022	Improvement in fever, stopped nausea & vomiting, weakness and in body ache. Temp: 98.6^o F, pulse: 90 bpm, BP: 124/80 mm of Hg	Rx, Nux Vomica 30 T.D.S.
13/12/2022	Improvement in fever, significant relief in constipation & other complaints with good sleep. Temp: 98.2^o F, pulse: 84 bpm, BP: 120/ 82 mm of Hg	Rx, Nux Vomica 30 BD Sac. Lac. HS for 3days
16/12/2022	Significant improvement Temp: 98.0^o, pulse: 80 bpm, BP: 126/80 mm of Hg	Sac. Lac. BD for 5 days

DISCUSSION:

Presenting the data that Homoeopathic medicines based on the theory of Individualization and symptom’s similarity with their physical, emotional and psychological makeup treats all types of fever in any of the diseased condition makes more easier by BBCR. In

Homoeopathic system of Medicine, Dr. C. M. Boger has worked on the concept of

Boenninghausen’s which helps to treat fever by prescribing the simillimum through Boger Boenninghausen’s characteristics & Repertory (BBCR) by giving separate fever chapter (fever totality) which gives arrangement in each stage of fever adding Time, Aggravation, Amelioration & Concomitant chapters through proper repertorization & has a great scope in preventing/curing any simple as well as complicated cases of fever.^[4]

CONCLUSION:

This case gives the brief understanding as well as remarkable explanation and utility of Boger Boenninghausen’s Characteristics and Repertory which is very effective in the cases of fever even of pathological conditions by its unique chapter of fever with forming a fever totality. Through this repertory & by complete individualization of a patient one can easily come to simillimum in an acute & chronic cases of fever.

REFERENCES:

Walker B, College N, Ralston SH, Penman IO, Davidson’s Principles and Practice of Medicine. 22^nd edition, Elsevier publication 2014.
Kasper D, Fauci A. Longo DL, Braunwald E, Hauser SL, Jameson JL. Harrison’s Principles of Internal Medicine. 17^th edition, The McGraw – Hill Companies, 2008.
Boger CM. Boenninghausen’s Characteristics & Repertory, 37^th edition, B Jain Publisher Ltd., 2012
Tiwari SK, Essentials of Repertorization, 5^th edition, B Jain Publisher Ltd., 2012

TITLE: UTILITY OF BBCR IN A CASE OF FEVER

AUTHOR DETAILS:

DR. HARIKRISHNA MANUBHAI KANODIA M.D. (HOM.)

HOD & ASSOCIATE PROFESSOR, HOM. PHARMACY

ACADEMIC IN CHARGE,

SMT. A. J. SAVLA HOMOEOPATHIC MEDICAL

COLLEGE & R. I., MEHSANA

Ph. D (SCHOLAR)

GUIDE: DR. NIDHI ARORA

TANTIYA UNIVERSITY, SRI GANGANAGAR