Adolescence is a transitional period from childhood to adulthood with a change from complete dependence to relative independence. One of the major physiological changes that take place in adolescent girls is the onset of menarche which is often associated with discomfort. Dysmenorrhea is the most common gynaecological disorder in young women that can affect their lives substantially. Almost 50% of all women experience Dysmenorrhea, and in 15% pain is severe enough to limit their daily activities. The term dysmenorrhea is derived from the Greek word “dys” meaning difficult, painful, or abnormal and “meno” means month and “rrhea” meaning flow.
Dysmenorrhea is defined as difficult menstrual flow or painful menstruation of sufficient magnitude to incapacitate day to day activities. It can be classified as primary dysmenorrhea based on the absence of identifiable pelvic pathology. Its usual onset occurs just before or during the time menstruation begins. Pain is usually in the pelvis or lower abdomen. Other symptoms may include back pain, diarrhoea, or nausea.
Worldwide, the prevalence of primary dysmenorrhea was estimated between 16% and 91%. Recent studies from India reported prevalence range between 50 to 87%. Primary dysmenorrhea is estimated to be the greatest cause of time lost from work and school. Nevertheless, one in two women experience pain during menstruation and one in three women must stay in bed for a minimum of two days every month. Many women attend their jobs despite reduced capacity to work during the periods of discomfort. The consequence is seen over her work output and the economy may be impossible to estimate.
The condition is related to the increased production and release of prostaglandins and other inflammatory modulators such as vasopressin and leukotrienes that can be found in the endometrial fluid. It usually appears within 2 years of menarche, with a family history of her mother or her sister suffering from dysmenorrhea. The pain is spasmodic and confined to the lower abdomen, may radiate to the back and medial aspect of the thighs. The severity of pain usually lasts for a few hours, may extend to 24 hours but seldom persists beyond 48 hours. The intensity of pain is acute on the first or second day of menses. These are correlated with the time of maximal prostaglandins release into the menstrual fluid.
In §17 & §18, Dr. Hahnemann stresses the importance of totality of symptoms. He says that physician only needs to remove the totality of symptoms to cure the disease & totality of symptoms are the only indication & guide to the selection of the remedy.
Dr. J. H. Clarke tells “the attempt to “cure” this affection by medicated interval douches is radically bad; & if it succeeds in its aim, it inevitable entails worse ill health for the patient; only such measures are required for cleanliness should be adopted.”
Dr. Stuart Close in ‘The Genius of Homoeopathy’ defines homoeopathic potentization as: It is a mathematic-mechanical process for the reduction, according to scale, of crude, inert or poisonous medical substances to a state of physical solubility, physiological assimilability and therapeutic activity and harmlessness, for use as homoeopathic healing remedies.
Dr. H. A. Roberts says “If homeopathy is a fundamental science, or a part of a fundamental science, as we believe, it must work in harmony with all the natural realms, and the laws which apply to those realms must apply also in some degree and relationship, to homeopathy.”
Dr. M. L. Dhawale writes, “That the constitutional peculiarities of a patient not only determine his susceptibility to the development of the illnesses but also the individualizing features that indicate the curative similar remedy.”
According to Dr. B. K. Sarkar, Hahnemann discovered a technique that involves a novel method of observation of the patient whereby it is noted the general aspects as well as the aspects in the setting of the generals, which characterize the uniqueness of the individual.
Dr. Elizabeth Wright states, “By suppression is meant that a disease manifestation is caused to disappear before the disease itself is cured.
As repetition of dose and administration of given remedy plays an important role in homeopathic prescribing, a rarely used method of repeating potency ‘Plussing Method’ was developed by Dr. Hahnemann and it was Dr. Elizabeth Wright who coined the term “Plussing.” Dr. Hahnemann has included this type of potency selection in his works namely “The Chronic disease” and “Organon of medicine.”
According to Dr. Hahnemann in aphorism 247 “It is impractical to repeat the same unchanged dose of a remedy once, not to mention its frequent repetition (and at short intervals in order not to delay the cure). The vital principle does not accept such unchanged doses without resistance, that is, without other symptoms of the medicine to manifest themselves than those like the disease to be cured, because the former dose has already accomplished the expected change in the vital principle and a second dynamically wholly similar, unchanged dose of the same medicine no longer finds, therefore, the same conditions of the vital force. The patient may indeed be made sick in another way by receiving other such unchanged doses, even sicker than he was, for now only those symptoms of the given remedy remain active which were not homoeopathic to the original disease, hence no step towards cure can follow, only a true aggravation of the condition of the patient. But if the succeeding dose is changed slightly every time, namely potentized somewhat higher (§ 269-270) then the vital principle may be altered without difficulty by the same medicine (the sensation of natural disease diminishing) and thus the cure brought nearer.”
In Chronic Diseases Preface Concerning the technical part of Homœopathy Dr. Hahnemann states that “Experience has shown me, as it has no doubt also shown to most of my followers, that it is most useful in diseases of any magnitude (no excepting even the most acute, and still more so in the half-acute, in the tedious and most tedious) to give to the patient the powerful homœopathic pellet or pellets only in solution, and this solution in divided doses. In this way we give the medicine, dissolved in seven to twenty tablespoonfuls of water without any addition, in acute and very acute diseases every six, four or two hours; where the danger is urgent, even every hour or every half-hour, a tablespoonful at a time; with weak persons or children, only a small part of a tablespoonful (one or two teaspoonfuls or coffee spoonful) may be given as a dose. In chronic diseases I have found it best to give a dose (e. g., a spoonful) of a solution medicine at least every two days, more usually every day.
Dr. Elizabeth Wright states that “Plussing means dissolving your dose in 1/3rd glass of water, taking two spoonsful, throwing away most of the rest, adding water up to the original quantity stirring and succussing and again taking two spoonsful as the second dose and so on. This raises the potency very slightly between each of the doses.” After administering the 1st remedy, the medicine is further repeated in Plussing method till the patient feels better. Such one or (increasingly) several teaspoonful doses are given daily or every second day in chronic diseases. In acute cases such doses can be repeated every 2 to 6 hrs and in very urgent cases every hour oftener. In chronic diseases the deep-acting remedies prepared in such a way may be repeated daily for months with ever increasing success. After such administration of the remedy for seven to fifteen doses, if the same medicine is found to be still indicated, one or several globules of the higher potency of the same drug is dissolved in requisite quantity of water and doses repeated as in the previous manner thus higher and higher potencies of the drugs may be continued till the patient experiences continued improvement.
Method of Plussing:
“One globule of 30C of medicine is dissolved in 7 to 8 tablespoonful of water and after thorough succussion (with 8, 10, 12, succussion) of the phial one tablespoonful is taken and put in glass of water (containing about 7 to 8 tablespoonful); then this is stirred thoroughly and the dosage is given.”
Plussing method is the process of administration of medicine in liquid form by diluting the given remedy in water and taking spoonful of it at regular interval, stirring before every dose. This is done to slightly change the potency so that the patient does not receive the same potency repeatedly. Plussing not only minimises the further risk of aggravation but also ensures a medicine’s more powerful impact.
I must mention the PLUSSING method – so called-of Hahnemann’s later days, which has only been realized since the publication of sixth edition of the Organon. Instead of the single dose, a series of doses may be given to start reaction, provided that the Potency be Altered for each dose. You will hear more about this method from those who have had more, favourable, experience of it. In acute disease where repetition is necessary, it certainly has its advantages; and it was the method Hahnemann again advocated in his earlier works; that is slightly changing the potency of the remedy with every dose.
Miasmatic Cleavage of Primary Dysmenorrhea
| PSORA | SYCOSIS | SYPHILIS | PSEUDO-PSORA |
| All functional menstrual disorders. Dysmenorrhoea shows itself very early, at puberty, at climacteric. Pain usually sharp, never colicky. | Pains and diseases of uterus, spasmodic, colicky, and paroxysmal. Acrid discharge, Pruritis, painful and frequent urination, mastodynia. Flow offensive, clotted, dark even black, fish brine odour | Depression and fears during menses. Profuse menstrual flow. | Painful, always exhausting, prolonged, copious. Feels badly a week before menses. Flow bright red, thin, watery. Headache, backache, neuralgias, epistaxis, diarrhoea, nausea, vomiting, cold extremities, febrile states. Hysterical, sad, gloomy, fear, sensitive, nervous irritability & inclination to weep. |
Inclusion criteria: • Female patients in age range from 14 to 25 years. • Clinical feature of primary dysmenorrhea must be present during most menstrual cycle that includes pelvic pain radiating to thighs and back, occurring just before or during menstruation. • Patients with regular menstrual cycle of 21 to 35 days. • Patient willing to give consent for the study.
Exclusion criteria: • Any female patient above 25 years. • Patients with previous abdominal or pelvic surgery or any underlying pelvic disease leading to secondary dysmenorrhea such as endometriosis, fibroids, polycystic ovarian syndrome, pelvic inflammatory disease. • Patients on hormonal contraceptives or intrauterine devices. • Patients with irregular menstrual cycle of more than 35 days or less than 21 days. • Parous women
Scales used for Monitoring:
WaLIDD scale survey assessed at the baseline and at the end of the study;
Conclusion:
Assessment of WaLIDD Score Before Treatment
| Sr. No. | Status | Number of cases | Percentage |
| 1. | Without dysmenorrhea | 0 | 0% |
| 2. | Mild dysmenorrhea | 0 | 0% |
| 3. | Moderate dysmenorrhea | 10 | 33.33% |
| 4. | Severe dysmenorrhea | 20 | 66.66% |
Assessment of WaLIDD Score After Treatment
| Sr. No. | Status | Number of cases | Percentage |
| 1. | Without dysmenorrhea | 8 | 26.66% |
| 2. | Mild dysmenorrhea | 20 | 66.66% |
| 3. | Moderate dysmenorrhea | 0 | 0% |
| 4. | Severe dysmenorrhea | 2 | 6.66% |
Patients coming under the age group of 14-24 years were included in study, 60% of its were under the age group of 14-19 years and 40% of patients were under the age patients p of 20-24 years.
Medicines based on symptom similarity were administered in all the cases. Pulsatilla was prescribed in5 (16.66%) of cases. Natrum mur. was prescribed in 4 (13.33%) of cases. Belladonna was prescribed in 3 (10%) cases. Sepia was prescribed in 3 cases (10%). Cimicifuga was prescribed in 3 cases (10%). Chamomilla, Lycopodium and Arsenic was prescribed in 2 cases each (6.66%). Ammonium carb., Calcarea carb., Calcarea phos. and Sulphur was prescribed in 1 case each (3.33%).
References:
- Qmidvar S, Bakouei F and Begum K. Primary Dysmenorrhea and Menstrual Symptoms in Indian female students. Prevalence Impact and Management. Global Journal of Health, Aug 2016.
- Ngoie CM. The efficacy of homeopathic complex compared to homeopathic similimum (30C plussed) in the treatment of primary dysmenorrhea. Dissertation submitted to Durban University of Technology. South Africa. June 2017.
- Wright E. A Brief study course in Homeopathy: Prescribing-Potency selection. Reprint edition 1999. New Delhi: B Jain Publishers Pvt. Ltd; 1999.
- Charandabi, S.M.A, Biglu, M.H, Rad, K.Y. Effect of homoeopathy on pain intensity and quality of life of students with Primary Dysmenorrhea: a randomized controlled trial. 1 Iran red crescent medical journal. 2016;18(9)
- Rehman Hine. et al. Approach to dysmenorrhea in ancient ages and its current relevance. International Journal of Herbal Medicine 2013;1 940;88-91
- Teheran, A.A, Pineros, L.G, pulido, F, Guatibonza, M.C.M. WaLIDD score, a new tool to diagnose Dysmenorrhea and predict medical leave in university students. International Journal of Women’s Health. 2018;10(10):
- Charandabi. S, Biglu. M, Rad. K. Effect of Homeopathy on Pain Intensity and Quality of Life of Students with Primary Dysmenorrhea: A Randomized Controlled Trial. Iran Red Crescent Med J. 2016 Sep; 18(9)
- Steefan JM, Nair SM, Mohan CK, Sisir PR, Sugathan NV,Chandraja CV. Homoeopathic management of acute febrile conditions using plussing method. IJHS 2020; 4(3):344-350
- Malhotra H. C., Menses and Health (mhh2), MALHOTRA H.C., A lady’s manual of homoeopathic care
- Charandabi. S, Biglu. M, Rad. K. Effect of Homeopathy on Pain Intensity and Quality of Life of Students with Primary Dysmenorrhea: A Randomized Controlled Trial. Iran Red Crescent Med J. 2016 Sep; 18(9)
