KIDNEY STONE

KIDNEY STONE – A HOLISTIC APPROACH

TO A COMMON URINARY TRACT DISORDER

Kidney stones, also called renal calculi, a kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Kidney stones are a common cause of blood in the urine (hematuria) and often severe pain in the abdomen, flank, or groin. Kidney stones are known to be one of the most painful and most common medical conditions. It occurs more frequently in men than in women and is rare in children. It shows a familial predisposition. Kidney stones usually originate in kidneys, but can develop anywhere along urinary tract. The urinary tract includes the kidneys, ureters, bladder, and urethra. Having stones at any location in the urinary tract is referred to as urolithiasis, the term nephrolithiasis is used to refer to stones located in the kidney and the term ureterolithiasis is used to refer to stones located in the ureters.

Urinary calculus is a stone-like body composed of urinary salts bound together by a colloid matrix of organic materials. It consists of a nucleus around which concentric layers of urinary salts are deposited.

Renal calculi can vary in size from as small as grains of sand to as large as a cricket ball. Most calculi originate within the kidney and proceed distally, creating various degrees of urinary obstruction as they become lodged in narrow areas, including the ureteropelvic junction, pelvic brim, and ureterovesical junction. Location and quality of pain are related to position of the stone within the urinary tract. Severity of pain is related to the degree of obstruction, presence of ureteral spasm, and presence of any associated infection.

Aetiology

Kidney stones form when there is a decrease in urine volume or an excess of stone forming substances in the urine. The most common type of kidney stone contains calcium in combination with either oxalate or phosphate. A majority of kidney stones are calcium stones. Other chemical compounds that can form stones in the urinary tract include uric acid, magnesium ammonium phosphate (which forms struvite stones), and the amino acid cysteine. The causes may includes

·     Hyperexcretion of relatively insoluble urinary constituents such as oxalates, calcium, uric acid, cystine and certain drugs such as magnesium trisilicate in the treatment of peptic ulcer.

·     Physiological changes in urine such as urinary ph (which is influenced by diet and medicines), colloid content, decreased concentration of crystalloids, urinary magnesium/calcium ratio,

·     Other causes like decreased urinary output of citrate, vitamin a deficiency, urinary infections, urinary stasis, hyperparathyroidism.

Risk factors

Kidney stones are most likely to occur between the ages of 20 and 40. Different factors can increase risk of developing a stone. Sex also plays a role, with more men than women developing kidney stones, according to the National Institute of Diabetes and Digestive and Kidney Diseases. A family history of kidney stones can increase risk.

Other risk factors include: dehydration, obesity, highprotein, salt, or glucose diet, hyperparathyroid condition, gastric bypass surgery, inflammatory bowel diseases that increase calcium absorption, taking medications such as diuretics, antiseizure, drugs, and calcium based medicines and antacids.

Types of stones

 Basically the renal stones can be divided into two major groups

·        Primary stones

·        Secondary stones.

Primary stones appear in apparently healthy urinary tract without any antecedent inflammation. There types are Calcium oxalate, Uric acid calculi, Cystine calculi, Xanthine calculi, Indigo calculi.

Secondary Stones are usually formed as the result of inflammation like Triple phosphate calculus, Mixed stones.

Clinical Manisfestations

Kidney stones are known to cause severe pain. Symptoms of kidney stones may not occur until the stone begins to move down the ureters. This severe pain is called renal colic. Colicky pain from “loin to groin”. Often described as “the worst pain ever experienced”.

Other syptos like hematuria (blood in the urine, due to minor damage to inside wall of kidney, ureter and/or urethra), Pyuria (pus (white blood cells) in the urine), dysuria(burning on urination when passing stones), oliguria (reduced urinary volume caused by obstruction of the bladder or urethra by stone, or extremely rarely, simultaneous obstruction of both ureters by a stone), Abdominal distension, Nausea and vomiting (embryological link with intestine – stimulates the vomiting center),Fever and chills, Hydronephrosis, Postrenal azotemia (when kidney stone blocks ureter), polyuria, loss of appetite and loss of weight.

Diagnosis

Diagnosis of kidney stones is made on the basis of information obtained from the history, physical examination, urinalysis, and radiographic studies. Clinical diagnosis is usually made on the basis of the location and severity of the pain, which is typically colicky in nature (comes and goes in spasmodic waves). Pain in the back occurs when calculi produce an obstruction in the kidney. Physical examination may reveal fever and tenderness at the costovertebral angle on the affected side.

Laboratory examination

Laboratory investigations typically carried out include microscopic examination of the urine, which may show red blood cells, bacteria, leukocytes, urinary casts and crystals; urine culture to identify any infecting organisms present in the urinary tract and sensitivity to determine the susceptibility of these organisms to specific antibiotics; complete blood count, looking for neutrophilia (increased neutrophil granulocyte count) suggestive of bacterial infection, as seen in the setting of struvite stones; renal function tests to look for abnormally high blood calcium blood levels (hypercalcemia); 24 hour urine collection to measure total daily urinary volume, magnesium, sodium, uric acid, calcium, citrate, oxalate and phosphate; collection of stones (by urinating through a StoneScreen kidney stone collection cup or a simple tea strainer) is useful. Chemical analysis of collected stones can establish their composition, which in turn can help to guide future preventive and therapeutic management.

Imaging. Imaging tests may show kidney stones in urinary tract. Options range from simple abdominal Xrays, which can miss small kidney stones, to highspeed or dual energy computerized tomography (CT) that may reveal even tiny stones. Other imaging options include an ultrasound, a noninvasive test, and intravenous urography, which involves injecting dye into an arm vein and taking Xrays (intravenous pyelogram) or obtaining CT images (CT urogram) as the dye travels through  kidneys and bladder.

General Management

Lifestyle changes

·        People who have a tendency to form calcium oxalate kidney stones may be advised to limit their consumption of foods high in oxalate, such as spinach, rhubarb, Swiss chard, beets, wheat germ, and peanuts. Also drinking lemon juice or lemonade may be helpful in preventing kidney stones.

·        Rather than having to undergo treatment, it is best to avoid kidney stones in the first place when possible. It can be especially helpful to drink more water, since low fluid intake and dehydration are major risk factors for kidney stone formation.

·         Fluid intake should he high at all times. Fluids should be taken at bed time so that nocturia will occur. This will prevent dehydration. Increasing total fluid intake to more than two liters per day of urine output.

·        Increasing citric acid intake; lemon/lime juice is the richest natural source.

·        Moderate calcium intake

·        Limiting sodium intake

·        Avoidance of large doses of supplemental vitamin C

·        Limiting animal protein intake to no more than two meals daily (an association between animal protein consumption and recurrence of kidney stones has been shown in men).

·        Limiting consumption of cola soft drinks, which contain phosphoric acid, to less than one liter of soft drink per week.

Home natural remedies

·        Lemon Juice, Olive Oil, and Raw Apple Cider Vinegar - This is one of the most effective remedies for kidney stones and the pain they cause. At the first symptom of stone pain, mix 2 oz of organic olive oil with 2 oz of organic lemon juice. Drink it straight and follow with a 12 ounce glass of purified water. Wait 30 minutes. Then, squeeze the juice of 1/2 lemon into 12 ounces of purified water, add 1 tablespoon of organic raw apple cider vinegar and drink. Repeat the lemon juice, water and apple cider vinegar recipe every hour until symptoms improve.

·        Uva Ursi is a common folk remedy for kidney stones. Not only will it help fight off infection in the kidneys, but it may also help reduce pain and cleanse the urinary tract. 500mg three times a day is recommended for kidney stones.

·        Organic dandelion root is a great kidney tonic and cleanser. Taking up to 500 mg twice a day may be beneficial.

·        Kidney beans - The shape of this bean may be indicative of its healing potential. An effective urinary home remedy for kidney stones, traditionally the pods were used as a medicinal tonic. Try removing the beans from inside the pods, and then boil the pods in purified hot water for six hours. This liquid can be strained through cheese cloth, cooled and taken throughout the day for one day to ease kidney stone pain.

·        We’ve all heard that pomegranates have many health benefits. But, more specifically, the seeds and juice of pomegranates can be considered another natural remedy for kidney stones. This may be related to their sourness and astringent properties. Prefer eating organic pomegranates and drinking freshlysqueezed pomegranate juice.

·        Studies show that people with recurrent kidney stones who took magnesium supplements had a 92.3 percent improvement rate in reduction of kidney stones. 300 mg of magnesium orotate is recommended daily for prevention and reduction of stones.

·        A kidney tonifier, basil tea can be taken throughout the day for overall kidney health. If you have kidney stones, try taking one teaspoon each of basil juice with raw honey daily for up to six months. It’s believed that folk remedies with pure basil juice can help induce stone expulsion from the urinary tract.

·        Horsetail tea is an effective natural remedy for kidney stones. Drink up to 34 cups of horsetail tea daily or 2 grams of the herb in capsule form daily.

Homoeopathic Management

Homoeopathy treats the person as a whole. It means that homoeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homoeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. The symptoms listed against each medicine may not be directly related to this disease because in homoeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy. None of these medicines should be taken without professional advice.

Medicine	Indication
Berberis Vulgaris	Renal colic < left side. Stitching, cutting pain from left kidney following course of ureter into bladder & urethra. Burning & soreness in region of kidneys. Pain in small of back, very sensitive to touch in renal region <when sitting & lying, from jar, fatigue. Numbness, stiffness & lameness with painful pressure in renal & lumbar regions. Bubbling sensation in kidneys. Urine greenish, blood red, with thick, slimy mucus, transparent, reddish or jelly like sediment. Rheumatic & gouty complaints with urinary diseases. < motion, any sudden jarring movement, walking, carriage riding.
Cantharides	Constant urging to urinate, passing but a few drops at a time, which is mixed with blood. Intolerable urging before, during & after urination. Violent paroxysms of cutting & burning in whole renal region. Violent tenesmus & strangury. Urine scalds him & is passed drop by drop. Membranous scales looking like bran in water. Urine jelly like, shredy. Pain raw, sore, burning in every part, internally & externally. Over sensitiveness of all parts. Drinking even small quantities of water increases pain in bladder.
Lycopodium	Renal colic, right sided. Pain shooting across lower abdomen from right to left. Pain in back relieved by urinating. Urine slow in coming, must strain. Retension. Polyuria during night. Red sand in urine. Uric acid diathesis. Child cries before urinating. Pains drawing, aching < 48 pm. Upper part of the body emaciated, lower part semidropsical. Ailments from fright, anger, mortification, reserved displeasure. Avaricious, greedy, miserly, malicious, pussilanimous. Excessive accumulation of flatulence, lower abdomen. > warm food & drinks.
Sarsaparilla	Passage of small calculi or gravel, renal colic, stone in the bladder. Excruciating pains from right kidney downwards. Severe almost unbearable pain at conclusion of urination. Urine bloody, scanty, slimy, flaky, sandy, copious, passed without sensation, deposits white sand. Painful distension & tenderness in bladder, urine dribbles while sitting, passes freely when standing. Air passes from urethra, child screams before & while passing urine.
Tabacum	Renal colic, violent spasmodic pains along ureter, left side. With deathly nausea & vomiting. Vomiting violent, with cold sweat, on least motion, with faintness > open air. Nausea incessant as if seasick > in fresh cold air. Vertigo, death like pallor, on opening the eyes. Face pale, blue, pinched, sunken, collapsed. Terrible, faint, sinking feeling at the pit of stomach. Icy coldness of surfaces.
Benzoic Acid	Excess of uric acid in urine. Urine high coloured, urinous odour highly intensified. Dark brown, highly offensive. Gonorrheal & syphilitic patients. Pain suddenly change their locality.Rheumatism & gout.
Nux vomica	Renal colic, right sided. Pain extends to the right thigh & to the genitals. Frequent ineffectual urge for urination with dribbling of urine. Haematuria, strangury. While urinating, itching in urethra & pain in neck of bladder. Backache, must sit up or turn over in bed. Adapted to thin, irritable, zealous, nervous, literary, studious, responsible persons. Bad effects of coffee, tobacco, alcohol, highly spiced food, overeating, long continued mental exertion. Over sensitiveness to all external impressions. Frequent ineffectual urging for stool.
Ocimum canum	Renal colic, right sided. Uric acid diathesis. Red sand in urine. High acidity, formation of spike crystals of uric acid. Turbid, thick, purulent, bloody, brick dust red or yellow sediment. Odour of musk. Pain in ureters, cramps in kidneys.
Dioscorea	Renal colic with pains radiating to the extremities. Colic pains < bending forward & while lying. > on standing erect or bending backwards. Violent twisting colic, occurring in regular paroxysms as if abdomen were grasped & twisted by a powerful hand. Pain suddenly shift to different parts, appear in remote localities as fingers & toes.
Belladonna	Violent spasmodic pains in kidney region especially of the right side. Pain comes suddenly, last indefinitely & cease suddenly. Pains usually in short attacks. Redness of eyes & face, throbbing of brain & carotids. Abdomen tender, distended, < least jar, even of the bed, slight noise, light, lying down. > pressure, tight bandaging, wrapping up. Bilious lymphatic plethoric constitutions.
Eryngium Aquaticum	Renal colic. Pain behind pubes. Congestion of kidneys with dull pain in back, running down the ureters & limbs. Difficult & frequent micturition. Strangury with nervous erethism. Tenesmus of bladder & urethra. Thick yellow mucus discharges.
Sepia	Red adhesive sand in urine. Chronic cystitis, slow micturition with bearing down sensation above pubes. > by violent exercise, warm application. Involuntary urination during first sleep. Urine highly offensive, must be removed from the room. Pains from other parts to back, attended with shuddering. Sensation of ball in inner parts. Weeps easily, indifference to those loved best.
Medorrhinum	Renal colic. Painful tenesmus when urinating. Severe pain in renal region > by profuse urination. Intense pain in ureters, with sensation of passing of calculus. Urine flows very slowly. Ailments from suppressed gonorrhea. Women with chronic pelvic disorders. < thinking of ailments, day time. > lying on abdomen.
Solidago	Urine scanty, reddish brown, thick sediment, dysuria, gravel. Pain in kidneys extends forward to abdomen & bladder. Urine difficult & scanty, albumen, blood & slime. Kidneys sensitive to pressure. Backache of congested kidneys.
Pareira brava	Renal colic, pain going down the thighs. Neuralgic pain in the anterior crural region. Constant urging, great straining. Can emit urine only when he goes on his knees, pressing head firmly against floor. Black, bloody, thick mucus urine. Dribbling after micturition. Urethritis, prostatitis.
Hydrangea	Renal calculi, gravel, profuse deposit of white amorphous salts in urine. Renal colic, sharp pain in loins, especially left. Burning in urethra & frequent desire. Urine hard to start. Bloody urine, heavy deposit of mucus. Great thirst with abdominal symptoms & enlarged prostate.
Thlaspi	Renal colic. Accumulation of gravel. Brick dust sediment. Urine heavy, phosphatic. Dysuria & spasmodic retension. Uric acid diathesis. Renal & vesical irritation. Urethritis, urine runs away in little jets. Haematuria & albuminuria.
Uva Ursi	Calculous inflammation. Chronic vesical irritation with pain, tenesmus & catarrhal discharges. Burning after the discharge of slimy urine. Frequent urging with severe spasms of the bladder. Urine contains blood, pus & much tenacious mucus, with clots in large masses. Painful dysuria. Involuntary green urine. Cystitis with bloody urine.

CHILDHOOD OVERWEIGHT & OBESITY – PREVENTION WITH HOLISTIC APPROACH

Childhood overweight and obesity is a serious medical condition that affects children and adolescents. Many children’s and young people struggle with excess weight. Almost 1 in 3 children ages 5 to 11 is considered to be overweight or obese. Weighing too many increases the chances that young people may develop some health problems now and later in life. It occurs when a child is well above the normal weight for his or her age and height. Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors. Obesity is defined as having excess body fat. Childhood obesity is a global phenomenon affecting all socio-economic groups, irrespective of age, sex or ethnicity. Childhood obesity is particularly troubling because the extra weight often pushes children on the path to health problems that were once confined to adults, such as diabetes, high blood pressure and high cholesterol. Childhood obesity can also lead to poor self esteem and depression. One of the best strategies to reduce childhood obesity is to improve the diet and exercise habits of entire family.

Classification

Developmental obesity – this category of obesity begins in the early years of a child’s life and continues steadily over the adult year. Hence, the foundation has already set in by the time the child is about four years old. The cells become saturated with fat and as the child grows older, more and more fat accumulates in the body. Muscle and bone mass also increases since the body has to carry additional weight. Such children usually grow tall, look older for their age and are obese right through infancy even up to their adult years. This type of obesity results in a higher lean body mass along with the fat.

Reactionary obesity – this type develops due to periods of emotional stress in a child’s life. During such stress periods the child may overeat resulting in increase in weight. However, since these periods are intermittent, the weight also reflects up and down.

Telling whether a child is overweight isn't always easy. Not all children carrying extra pounds are overweight or obese. Some children have larger than average body frames. And children normally carry different amounts of body fat at the various stages of development. Children grow at different rates at different times. Also, the amount of body fat changes with age and differs between girls and boys.

One way to determine a person's weight status is to calculate body mass index (BMI). The BMI measures a person's weight in relation to his or her height. The

BMI of children is age and sex specific and known as the "BMI for age”.

Causes

Many factors usually working in combination in increase child's risk of becoming overweight like

·        Diet - Regularly eating high calorie foods, such as fast foods, baked goods and vending machine snacks, can easily cause child to gain weight. Soft drinks, candy and desserts also can cause weight gain.

·        Lack of exercise. Children who don't exercise much are more likely to gain weight because they don't burn as many calories. Too much time spent in sedentary activities, such as watching television or playing video games, also contribute to the problem.

·        Family factors. If child comes from a family of overweight people, he or she may be more likely to put on weight. This is especially true in an environment where high calorie foods are always available and physical activity isn't encouraged.

·        Psychological factors. Some children overeat to cope with problems or to deal with emotions, such as stress, or to fight boredom. Their parents may have similar tendencies.

·        Socioeconomic factors. People in some communities have limited resources and little access to supermarkets. As a result, they may opt for convenience foods that don't spoil quickly, such as frozen meals, crackers and cookies. In addition, people who live in lower income neighborhoods may not have access to safe places to exercise.

Though not common, there are also genetic diseases and hormonal disorders that can make a child prone to obesity. Endocrine disease like Hyperpituirism, hypothyroidism, Cushing syndrome, Genetic syndromes like prodderWilli, LaurenceMoonBiedi, turner syndrome, CNS lesions like  infection, surgery, radiation, cranio-pharyngioma, Miscellaneous like steroids, anti – epileptics drugs.

Physical complications

Type 2 diabetes -  Type 2 diabetes is a chronic condition that affects the way your

child's body uses sugar (glucose). Obesity and a sedentary lifestyle increase the risk of type 2 diabetes.

Metabolic syndrome - Metabolic syndrome isn't a disease itself, but a cluster of conditions that can put your child at risk of developing heart disease, diabetes or other health problems. This cluster of conditions includes high blood pressure, high blood sugar, high triglycerides, low HDL ("good") cholesterol and excess abdominal fat.

High cholesterol and high blood pressure - child can develop high blood pressure or high cholesterol if he or she eats a poor diet. These factors can contribute to the buildup of plaques in the arteries. These plaques can cause arteries to narrow and harden, which can lead to a heart attack or stroke later in life.

Asthma - Children who are overweight or obese may be more likely to have asthma.

Sleep disorders - Obstructive sleep apnea is a potentially serious disorder in which a child's breathing repeatedly stops and starts when he or she sleeps. It can be a complication of childhood obesity.

Nonalcoholic fatty liver disease (NAFLD) - This disorder, which usually causes no symptoms, causes fatty deposits to build up in the liver. NAFLD can lead to scarring and liver damage.

Early puberty or menstruation - Being obese can create hormone imbalances that

may cause puberty to start earlier than expected.

Social and emotional complications

Low selfesteem and bullying - Children often tease or bully their overweight peers, who suffer a loss of selfesteem and an increased risk of depression as a result.

Behavior and learning problems - Overweight children tend to have more anxiety and poorer social skills than normal weight children have. At one extreme, these problems may lead overweight children to act out and disrupt their classrooms. At the other, they may cause overweight children to socially withdraw.

Depression - Low selfesteem can create overwhelming feelings of hopelessness in some overweight children. When children lose hope that their lives will improve, they may become depressed. A depressed child may lose interest in normal activities, sleep more than usual or cry a lot. Some depressed children hide their sadness and appear emotionally flat instead. Either way, depression is as serious in children as in adults.

MANAGEMENT

Some tips to avoid overweight and obesity in childrens

Parents and other caregivers can play an important role in helping children build healthy eating and physical activity habits that will last a lifetime.

·        To help child develop healthy habits, be a positive role model. Children are good learners and they often mimic what they see. Choose healthy foods and active pastimes for yourself.

·        Educate the whole family in building healthy eating and physical activity habits. This benefits everyone and doesn't single out the child who is overweight.

·        A healthy eating plan limits foods that lead to weight gain. Foods that should be limited include these: fats that are solid at room temperature (like butter and lard), foods that are high in calories, sugar, and salt like sugary drinks, chips, cookies, fries, and candy, refined grains (white flour, rice, and pasta)

·        Just like adults, children should replace unhealthy foods with a variety of healthy foods, including these: fruits, vegetables, nuts and seeds, and whole grains like brown rice, fatfree or lowfat, milk and milk products or substitutes, like soy beverages that have added calcium and vitamin D, lean meats, poultry, seafood, beans and peas, soy products, and eggs

·        Keep healthy snack foods on hand like airpopped popcorn without butter, fresh, frozen, dried, or canned fruit served plain or with lowfat yogurt, fresh vegetables like baby carrots, cucumber, zucchini, or tomatoes

·        Kids need about 60 minutes of physical activity a day, but this doesn't have to happen all at once. Several short 10 or even 5minute periods of activity throughout the day are just as good. If children are not used to being active, encourage them to start with what they can do and build up to 60 minutes a day.

·        Exercise like catching and throwing a ball, climbing on a jungle gym or climbing wall, dancing, jumping rope and playing hopscotch helps in reducing weight.

·        Encourage child to join a sports team or class, such as basketball, dance, or soccer at school or at your local community or recreation center. If child feels uncomfortable participating in activities like sports, help him or her find physical activities that are fun and not competitive, such as dancing to music, playing tag, jumping rope, or riding a bike.

HOMOEOPATHIC MANAGEMENT

Homoeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homoeopathy is not only to treat childhood obesity but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat obesity in children that can be selected on the basis of cause, sensations and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. A holistic approach considering the lifestyle, personal habits, food habits, inclusion of nutrients and diet, etc. along with homoeopathic treatment helps in overcoming overweight and obesity of children’s. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition.

Medicine	Indication
Ammonium  muriaticum	Especially suited to those who are fat and sluggish and whose bodies are large and fat with large buttocks, fatty tumors and thin legs. All mucus secretions are increased and retained. Generally suffering from respiratory troubles and associated affections of liver. Obstinate constipation accompanied by much flatus. Hard, crumbling stools require great effort in expulsion; crumble from the verge of anus.
Thyroidinum	It produces anemia, emaciation, muscular weakness, and sweating, tingling and increased heart rate. It exerts great influence over goiter and excessive obesity and acts best in females with paleness and uterine fibroids or mammary tumors.
Antimonium crudum	Obesity in young people with excessive irritability and fretfulness together with a thickly coated white tongue. All the conditions aggravate by heat and cold bathing. Tendency to grow fat. For children and young people inclined to grow fat, for the extremes of life. Old people with morning diarrhea suddenly become constipated or alternate diarrhea and constipation, pulse hard and rapid. Sensitive to the cold. < After taking cold. Child is fretful, peevish, cannot bear to be touched or looked at, sulky, and does not wish to speak or be spoken to, angry at every little attention. Great sadness, with weeping. Longing for acids and pickles. Gastric and intestinal affections: from bread and pastry; acids, especially vinegar; sour or bad wine; after cold bathing; overheating; hot weather. Worse – After eating; cold baths, acids or sour wine; after heat of sun or fire; extremes of cold or heat. Better – In the open air; during rest; after a warm bath.
Graphites	Tendency to obesity in females with delayed menstruation. The patients are stout, of fair complexion and tendency to skin affections and constipation, fat, chilly and costive. Take cold easily. Tendency to obesity and swollen genitals with indurations of tissues.
Phytollaca	An important remedy for obesity. Reduces fat and false growths. It is preeminently a glandular remedy with glandular swellings –heat and inflammations. Helps to reduce fat and thus reduce weight. It is useful in rheumatism of syphilitic origin where the pains are wandering, shifting and shooting. Burning in throat as from coal fire and cannot swallow hot liquids. General soreness, lameness, bruised feeling over whole body causes the patient to groan. Intense prostration, sitting upright makes him faint and dizzy. Mother tincture is used for weight reduction.
Fucus	A good remedy for obesity and nontoxic goiter (also exophthalmic). Digestion is improved and flatulence diminished. Obstinate constipation. Thyroid enlargement in obese people.
Calcarea arsenicum	Complaints in fat women around climacteric or women approaching climaxis. The females tend to become fleshy and obese around menopause. Chilliness with dropsicalaffections. Cancer of uterus, affections of spleen and mesenteric glands are often found associated. Great mental depression. The slightest emotion causes palpitation of heart
Capsicum	Suits nicely those people who are of lax fibers, weak, diminished vital heat, fat/obese, indolent and have no vital heat or no reactive force. General uncleanliness of body and opposed to physical exertion. Burning pains and general chilliness with marked tendency to suppuration in every inflammatory process are found.
Phosphorus	Persons of waxy, translucent skin, half anemic, young people growing too rapidly, fair, blondes, quick and hemorrhagic diathesis. It affects the nutrition and function of every tissue of body. It causes pseudohypertrophy of muscles. Adapted to tall slender persons of sanguine temperament, fair skin, delicate eyelashes, find blond or red hair, quick perceptions, and very sensitive nature. Young people, who grow too rapidly, are inclined to stoop who are chlorotic or anemic; old people, with morning diarrhea. Hemorrhagic diathesis; small wounds bleed profusely from every mucous outlet. Longs for: cold food and drink; juicy, refreshing things; ice cream > gastric pains. As soon as water becomes warm in stomach it is thrown up. Worse – Evening, before midnight, lying on left or painful side; during a thunderstorm; weather changes, either hot or cold. Cold air relieves the head and face symptoms but aggravates those of chest, throat and neck. Better – In the dark; lying on right side; from being rubbed or mesmerized; from cold food, cold water, until it gets warm.
Lac defloratum	Useful in obesity and where diseases are associated with faulty nutrition. Sick headaches with intense throbbing, nausea and vomiting, prostration and all complaints aggravated during menses.
Kali bichromicum	It is specially indicated for fleshy, fat, light haired complexioned people with scrofulous or syphilitic history. Symptoms tend to increase in the morning and all pains migrate quickly with rheumatic and gastric symptoms alternating. Catarrhal stage of all mucus membranes.
Pulsatilla	It is preeminently a female remedy with tendency to obesity in mild, gentle, yielding females who are sad, cry easily and weeps when talking. The symptoms are changeable and contradictory. The patient seeks the open air and feels better in it. Thirstlessness and chilliness in fat females. Aversion to fatty foods, still grows obese. Adapted to persons ofmild, gentle, timid, yielding disposition – the woman’s remedy. Weeps easily: almost impossible to detail her ailments without weeping. Especially, in diseases of women and children. Women inclined to be fleshy, with scanty and protracted menstrual tion.
Sepia	Obesity in females with weakness, yellow complexion and bearing down sensations. Pains extend down to back and patient chills easily. Obesity in menopausal females with hot flushes and perspirations. Particularly sensitive to cold air, “chills so easily;” lack of vital heat, especially in chronic diseases. Great sadness and weeping. Dread of being alone; of men; of meeting friends; with uterine troubles. Indifferent: even to one’s family; to one’s occupation, to those whom she loves best. Greedy, miserly.
Senega	Especially suited for persons of lax fibers who tend to become obese and also to children who are chubby in appearance. These children usually suffer from repeated respiratory catarrhal affections where rattling cough and profuse mucus but difficult raising are characteristics.