Welcome User!
Case Study

Homoeopathic management of disorders of Lumbar inter-vertebral discs
Dr Prasad Rasal

In aphorism No 3 of 6th edition of organon of medicine, Dr Hahnemann says that: The homoeopathic physician should have following knowledge in order to achieve IDEAL CURE.
(1) Knowledge of disease, indications.
(2) Knowledge of medicinal powers.
(3) Choice of the remedy, the medicine indicated.
(4) Proper dose. and
(5) Obstacles to recovery.
So, here the first point explained is of very much importance while dealing with Lumbar Intervertrebral Disc Disorders i.e."KNOWLEDGE OF DISEASE , INDICATION"

The sentence is divided into two parts:
1) Knowledge of Disease: ie understand the pathogenesis and pathology, so we can handle the patient better.
2) And later on how the same disease expresses in an individual ie (Knowledge of Patient- Individualisation.
So, first let us understand the important disorders of LUMBAR INTERVERTEBRAL DISCS.
Two important disorders of Lumbar inter-vertebral discs are: 1. Lumbar Disc Prolapse
2. Lumbar Spondylosis

Generally in homoeopathic practice, clinical examination, clinical diagnosis, laboratory investigations and special investigations are overlooked by a number of homoeopaths. Only symptomatic approach is used by them and that’s why even the best Similimum fails as case is treated without understanding of disease pathogenesis. No proper auxiliary methods are tried. That is why, I always use the word homoeopathic management than Homoeopathic Treatment.
We will discuss the management of above discussed Lumbar Inter-vertebral Disc Disorders.

(A) Acute prolapsed lumbar inter-vertebral disc with lower radiculopathy.
In acute phase:
(1) Immediate Hospitalisation and Continuous Lumbar Traction or Complete bed rest depending upon severity of pains (for 4 days to 10 days )
(2) Acute similimum
(3) When patient comes out of pains, gradual Spinal Extension Exercises to prevent further prolapse of inter-vertebral disc.
(4) Ask the patient not to lift heavy weight by direct forward bending.

(B) Chronic prolapsed lumbar inter-vertebral disc with lower radiculopathy
If disease is chronic with ACUTE exacerbation, same management is needed to take over acute episode followed by (and even in chronic disease itself) finding out :
1. Deep Acting Chronic Constitutional Medicine.
2. If needed, use of deep acting bio-chemic medicine supplementation select on General Biological Action of Medicine,
3. If needed, use of miasmatic NOSODE depending on individualisation.
4. Asking patient to avoid lifting heavy weight with direct forward bending.
5. If patient is of old age use of Lumbo sacral corset or belt during working and travelling.
6. When pains subsides, gradual increase of spinal Extension Exercises.

Mr Y S K 59 yrs/M. Retired primary teacher now a Farmer.
First came on - 18/07/1998
Diagnosed case of Degenerative disc disease with marked narrowing of spinal canal at L 3-4 with disc prolapse at L 4-5 causing severe focal canal stenosis. [Xerox copies of Reports MRI attached]. Patient was posted for Laminectomy and Discoidectomy,.

Chief Compalints and Associated Complaints

Since three months.....





Rt lower extremity


throbing, neuralgic

Claudication in both legs

A/F : lifting weight

< lying on Rt. side 
< bending toward 
< walking 
> pressure 
> complete rest 
< slightest motion 
< Walking very small distance


Past History: Haemorrhoidectomy 1994
Family History: Father - Koch’s
Personal History:
1. Appetite-normal
2. Thirst-Large quantity of water 3-4 hrly
3. Desires-Sweets ++, Tobacco ++, Salt ++
4. Micturition-Normal
5. Bowels-Normal
6. Perspiration-Neck ++, Offensive ++, Staining yellow ++.
7. Sleep-Disturbs due to pains
8. Dreams-Frightful, farm about
9. Thermals-Ambi-thermal, but always desires fans

Mental State: Disturbed due to disease as he has to lie down all the time and cannot work. He is always thinking about disease with fear of surgery. Anxiety about household problems i.e. marriage of son, building house etc. Quiet, yet dominating in house. But fears quarrels. Religious ++, Emotional ++, Loquacity ++, Expressive ++, Dominating ++, Dictatorial ++, Suspicious ++ and doubtful about recovery. Leadership in service previously, Never likes contradiction, irritable with violent ++ anger. Patient has three sons and a daughter. Only daughter married. Always quarrels with cousins regarding farm. Likes to remain in company and tries to maintain friendship.
Physical General Examination:

·         Male pattern baldness with gray hair

·         Flabby and trembling tongue

·         Tall, slender, emaciated

·         Weight: 58 kg

Systemic Examination:

·         Straight leg raising test (SLR) Right side: +ve

·         Femoral roots stretch test (FRST) Right side: +ve

Investigations done: 07/14/98
Hb:10 Gm % TLC - 7400/mm DC: N: 58, L: 37, E: 3 M: 2, B: 0
Tuberculin Test : -ve
MRI lumbo sacral spine: Wide spread degenerative diseased disc with marked narrowing of L 3-4 disc. Large diffuse disc bulge at L 4-5 causing marked thecal sac compression and severe focal canal stenosis. Milder degree of disc bulge at L 3-4 and L 5-S1. Bilateral root compression of L 3-4.

DIAGNOSIS: Severe lumbar canal stenosis due to degenerative disc disease and PID at L 3-4, L 4-5, L 5-S1 with right lower radiculopathy.

Patient has wide spread degenerative disc disease with acute exacerbation of PID with right lower radiculopathy due to lifting weight. So even though disease is originally a chronic dynamic one, it also has an acute mechanical problem Giving only medicine will cure his prolapsed inter-vertebral disc and the radiculopathy. Whenever an inter-vertebral disc prolapses, nerve root oedema develops immediately. Removing nerve root oedema is of prime importance. Absolute bed rest achieves 60-70% of nerve root oedema reduction. So case should be managed properly to get absolute result.
Our main aim is to relieve patient’s suffering as early as possible. Otherwise patient will go for operation.
Patient was admitted in our Homoeopathic hospital for eight days.
Continuous lumbar traction for eight days which provides absolute bed rest. Regular soft diet was provided. Tobacco was stopped completely.
As the case is of chronic degenerative disease, our selection of drug should be deep acting medicine to cope up the situation.
MIASMATIC BACKGROUND: Considering family history of Tuberculosis, past history of Haemorrhoidectomy and patient’s present degenerative disorder and mental state of jealous, suspicious, quarrelsome, dominating, violent, leadership
is dominating. So our search should be towards such medicine, as to cover all these aspects.

Anti-miasmatic Nosode: Tuberculinum
Deep acting chronic constitutional: Lachesis selected on following rubrics

  1. Dictatorial
  2. Jealousy
  3. Suspicious
  4. Quarrelsome
  5. Violent
  6. Loquacity
  7. Pain, lower limb, sciatica, right

BIO-CHEMIC APPLICATION: To help the homoeopathic medicinal action and to hasten cure, I always uses Biochemic medicines in such chronic degenerative disorders based on its general biochemic action of biochemic medicine.
Chronic degenerative disorders of spine with oesteophyte formation is covered by Calcaria-fluor.

Therefore, Four medicines come out:

  1. Chronic constitutional: Lachesis 200. Potency: 200 potency as chronic pathology with degeneration. Single dose is sufficient to arouse the Vitality.
  2. Acute totality: Bryonia 10M TDS. Potency: 10M potency as an Acute Similimum to relieve the spasm.
  3. Biochemic application: Calcaria-flour. 6X - Biochemic dose in decimal scale.
  4. Nosode: Tuberculinum

Lachesis 200 one dose on 1st day.

Next day Bryonia 10M TDS for 10 days.
Calcaria-fluor 6X TDS for 10 Days (Bio-Chemic Application).

HOSPITALISATION PROGRESS: After applying continuous lumbar traction from 18thJuly 1998, on 3rd day i.e. on 21st, patient’s pain completely relieved. SLR FRST became negative (-ve). Lumbar traction continued for 3 more days. On 24t h, patient was asked to walk for certain distance on plain surface. No pain after walking. Lumbar traction stopped. Only bed rest continued along with medicines. On 25th, patient walked nearly ½ km without suffering. Continued medicines and bed rest.
On 26th, patient walked 1 km without suffering. Patient discharged and called after 10 days.

TREATMENT ON DISCHARGE: Advised Bed Rest as far as possible.While walking, use lumbo-sacral corset. Placebo TDS for 10days
Calcarea- fluor 6x tds for 10 days

08/07/98: Able to walk 2 km on pain surface. No pains. Occasional Coryza.
Auxiliary Treatment: Gradual spinal extension exercises.
Calcarea- fluor.6x BD for 1 month.
09/11/98 : No complaints. Doing exercises regularly. Walks 3-4 km a day.
Can work in field. Continue Spinal Extension Exercises. Calcarea- fluor 6x OD for 2 months.
11/12/98: No complaints. Use of Lumbo-sacral corset only during travelling.
Continue spinal extension exercises. Tuberculinum 1M 1 dose stat (Anti Miasmatic)
03/01/99 : No complaints. Continue spinal extension exercises. NO MEDICINE.
08/28/99 : No complaints. Ct Spinal Extension Exercises.