1

Part 1
The term short febrile illness is to be preferred to the earlier general term viral
fever for fevers less than 7 days duration
SFI (Short febrile illness)
Usual Presentation
Temperature more than 38.5 C for more than two consecutive days. It may be
continuous or remittent without severe chills or rigor.
Non specific headache which correspondingly increases with temperature
Dry cough with minimal white mucoid sputum
General aches and pains without real arthritis
Running nose, sneezing and nasal block characteristic of influenza
A reasonable provisional diagnosis of SFI can be made. 90% have uneventful
recovery within 7 days.
While arriving at a diagnosis, routine examinations of vital signs and basic
investigations may be made and rule out other diseases.

General approach
If fever presentation is on first day - make a provisional diagnosis and manage
based on symptoms and relevant history
If fever has history of more than 3 days or has been treated partly - diagnosis
should include investigations and proper decisions on management or referral
should be made

Approach to short febrile illness

With a specific localizing cause----like, injury, abscess, skin infection, etc- ---
investigate, collect relevant totality and manage
Without any localizing cause---
a) If with upper respiratory symptoms-sore throat, rhinorrhoea, sneezing, cough
etc--- suspect ARI, SARI, scrub typhus ILI. In children consider pertussis and
diphtheria also
b) If without upper respiratory symptoms-consider dengue, malaria,
leptospirosis, chikungunya etc
 2

c) With rash, petichae-think of measles, dengue, IMN, rubella, HFM, yellow

fever etc
d) With GIT symptoms like diarrhoea or vomiting suspect, food poisoning,
dengue, yellow fever, malaria, typhoid
e) With neurological signs- JE, meningitis

ALWAYS check these vital signs

1) Pulse rate (PR/HR) normally increase of 10 beats per degree F, or 18 per
degree C rise of temp. If increased out of proportion----- suspects myocarditis,
rheumatic fever.
2) Tachypnoea – respiratory rate out of proportion to temperature (16-24) more
than 30 – suspicion of bronchopneumonia (children up to 2 months> 60,2mo- 1
yr >50,1yr- 5 yr>40)
3) BP – always check in unusually sick fever cases – hypotension- impending
shock (sepsis), dengue shock syndrome
4) Sensorium – altered in meningitis, encephalitis, AES (Acute Encephalitis
Syndrome), cerebral malaria etc
5) Record temperature and verify with pulse rate
Next make a systemic examination also
6) Inspect for evidence of pharyngitis, tonsillitis, throat ulcers or abscesses
(H1N1)
7) Auscultate the heart for tachycardia, murmur or gallop (myocarditis)
8) Auscultate lung for bronchial breathing, crepetitions/rhonchi
(bronchopneumonia, H1N1)
9) Palpate the abdomen for hepato splenomegaly or renal mass (haemolysis,
hemorrhagic fevers)
10) Look carefully in skin of extremities, face for discoloration, petichae etc
(hemorrhagic signs),eschar
11) Check for neck rigidity- kerning’s sign, brudenzkis’s sign (meningitis)
12) Conjunctiva for yellow discoloration, suffusion (redness)
Thus we can reasonably suspect these disorders by checking the vital signs and
hence it is a MUST and is done in any fevers. Once you have a suspicion
confirm it by relevant laboratory examinations. Usually need to be done after 2
day of non resolving fevers
 3

When and how to investigate- general approach

a) First 3 days- No special investigations are not required unless definitely

indicated by ‘sick look’ or unusual symptoms.

b) If the area reports show there is wide prevalence of specific fevers like
lepto/dengue/JE/scrub etc and do appropriate screening tests

c) Communicate to the patient/ relatives the logic of your decision to investigate

or not to investigate. If sending for investigation brief them about the relevance
of test, place of investigation and the approximate cost of it if you know

Simple tests reveal a lot;

Blood
TC, DC, ESR, platelet count- Neutrophil leucocytes in leptospirosis, while
neutropenia in usual viral fevers, typhoid
platelet count is decreased in hemorrhagic fevers,
haematocrit( PCV) rises in DengueShock Syndrome,dehydration.
2)Urine routine- shows pus in UTI, RBC , albumin in leptospira infection
3) Chest X RAY- PA view- -homogenous or patchy shadows -
bronchopneumonia
4) LFT - imapaired in lepto spirosis and yellow fever

Serological tests are costly but more confirmatory and available only in
specialized labs IgM Dengue, IgM lepto can confirm your suspicion. You
should know where these tests are available in your locality.NS1Ag is the latest
screening test which can diagnose dengue fever within 48 hours
Case definition
If the case corresponds to the above symptomatology of a disease it shall be
called as suspected case
If the case comes from the area of the identified cases and has a contact history
we shall define it as a probable case
If the confirmatory diagnostic investigations are carried out and is positive then
only it is considered as a confirmed case.
4
 5

Follow up/ review/reference guidelines

While treating febrile illness look for these 8 (eight) warning symptoms on
review
1)Rash-lepto, dengue,IMN 2) fits- meningitis 3) bleeding from any site-
haemorrhagic fevers( lepto dengue) 4) Jaundice (leptospirosis, hepatitis,
malaria 5) reduced quantity of urine(lepto) 6) breathing
difficulty(bronchopneumonia) 7) altered behavior (encephalitis, JE,KFD)
8)eschar.
If the case show progressively deteriorating platelet count, rising haematocrit
and reducing pulse pressure and going into shock and need blood transfusion,
fluid replacement, oxygen, dialysis.
Be sure that the patient has those facilities in the place you treat or sent him to
such institution soon. These critical period happen usually from the third day in
dengue, leptospirosis etc
These symptoms herald a potentially fatal situation is on the offing and has to
be managed with extreme care and caution
Be sure that your medicine is acting in the time frame as you have expected.
NEVER GIVE MEDICINE CASUALY AND ASK TO COME FOR
REVIEW AFTER A FEW DAYS. The case has to be personally reviewed
every 4-8-12-24 hours (Stuart close- repetition) in such situation. If it is not,
consult your senior physician having your confidence and take a decision for
follow up or reference.

Supportive management and advices

a) Fluids – especially kanji with a little added salt taken in small quantities at
frequent intervals is a good diet in fever and dehydration

b) IV fluids only in severe dehydration, shock, persistent vomiting or when the

patient is too sick to drink or eat

c) Tepid (slight warm water) sponging is the best and it should be done over
whole body and not just on forehead alone

d) Rest is most important factor and parents should be strictly instructed not to
send their children to school till they are totally symptom free

e) Do not cover the body with thick blanket or caps as they tend to rapid increase
of temperature, shivering and febrile fits Use light cotton loose dress
 6

Part 2
Case identification
Here we are dealing with acute epidemic fevers i.e. acute miasmatic fevers. It
may be a fixed miasm where the characteristic features remain the same or it
may be differing in character or symptoms every year
Case taking
Acute case taking is limited to acute totality (presenting complaints and history
of presenting complaints- this includes the most probable etiology) completion
of symptom and confirmation of the symptom by requestioning is the key to
acute totality Case Analysis
Characteristic symptoms of the disease can be considered as characteristic
symptoms which helps us to find a desired remedy which is capable of
producing a ‘curative artificial disease very similar to the totality of symptoms
of the natural disease.
Symptoms which are constant, frequent, strongest and most troublesome to the
patient are to be given more value (Lesser writings- medicine of experience)

Rubric selection for repertorisation proper

In acute cases, every confirmed symptom should be considered for
repertorisation.
Initially the characteristic symptoms should be taken for repertorisation.
Rubrics with similar meaning should not be repeated
Linking of symptoms with age and season should be limited.
Rubrics should be as specific as possible.
Rubrics with very few remedies are to be considered under remaining
symptoms
Common symptoms are to be listed under remaining symptoms

First consultation in the initial febrile period (1-2 days)

Most of the symptoms found in flavi virus infection (dengue, yellow fever,
KFD) seem to be similar in the initial 1-2 days. Leptospirosis or SFI also
presents similar symptoms.
Common symptoms and rubrics taken in SFI/ other viral infections may be as
follows. You may select the rubrics and decide on its severity and grade it. All
the symptoms which clinically characterize the disease may be included for
repertorisation. It is this medicine which we may select as genus epidemicus
also
 7

Headache during fever

Coryza heat during
Cough heat during
Retro orbital pain during fever
Chillness fever during,
Back pain fever during/ chill during
Extremities pain fever during
Fever / heat - side
Chill periodicity/ time
Vomiting fever/ chill during
Diarrhoea fever during
Throat pain- dysphagia
Prostration/ weariness fever during
Fever continous, typhoid
Bladder frequency
Skin- eruption petichae / ecchymosis + drowsiness, lassitude, lie desire to
fever during/restlessness chill during,+ thirstlessness fever during ,dryness +/_
intense thirst which is marked + characteristic thermal modality. Exciting
factors like wet agg, becoming cold, exertion agg, becoming cold after exertion
agg, etc can be a valuable point in individualization.

This will present a group of remedies. In homoeopathy the differentiating

points may be the severity of these symptoms itself along with the general
modalities and other specific characteristic particular symptoms which may
prop up. The practitioner can take these rubrics for selecting medicines. 90% of
cases revolve around 15-20 medicines and so a rubrical analysis of the
common medicines in febrile conditions are also being attached for reference
(Annexure3). A strong characteristic mental general can supersede many
particulars and the medicine may change but in homoeopathy it cannot be ruled
out. This exercise may be repeated every year by IHRC and such symptoms
may be marked out. There are some useful indications of medicines of
influenza given by our masters in therapeutic books which may not reflect in
repertory. These also have been taken into account. Pathological rubrics along
with characteristic rubrics will help in individualizing the remedy.
Now the list is populated with 15-20 medicines which we think covers the
above mentioned initial symptoms of febrile illness
Nux V, Bry, Rhus Tox, Gels, Pyrogen, Eupat Perf, Bell, Baptisia, Merc sol, Ars
alb, Arnica, Acid nit, Ipecac, nat mur, phos, carbo veg, Eucalyptus, Puls
 Aim 8
It should prevent the complications of the critical period or abort it
and end in early uncomplicated cure

First step 1 (a) – Find out the main and constant pathological symptoms of the
febrile case (1-2 days) and match with the limited rubrics given above. -
Repertory charts help you to arrive at group of medicines .If there is
concordance and feel the indicated remedy is in the above group go to step 2.
1(b) If there is no concordance take the usual repertorizing route

Step two 2 - Check out the remaining symptoms /rubrics from the medicine
rubrics

2(b) the expressions of masters in the literature for confirmation

Step three 3- Selection of potency, dose and repetition

If vitality is high and symptoms are intense, better to start with 200 or 1M or 10
m and if vitality is low Q, 3x, 30th potency is preferred
Defining vitality -? (mentally alert, physically active except the tiredness of
illness, no sick look, no major variation in basic cardiac, hepato, renal, neuro
parameters –good vitality)

3(b) Repetition- There is only one accepted law in organon as said in aph
245.When the response to first dose is increasingly perceptible and rapidly
increasing amelioration no repetition. On the other hand if the response is slow
improvement, then the medicine may be repeated at suitable intervals. In very
acute cases it may be repeated every hour, half hour or every fifteen minutes.

4 Follow up- Though in some cases the response may be rapid, it is reasonable
enough to request the patient to do a self assessment after 4-6 hours and decide
to repeat (if the improvement is slow/feel good is present but clinically no
improvement) to wait if there is good improvement (symptomatically and
clinically) and to report to the physician in case of warning signs (more vital
organs affected) whereupon physician decide to change the medicine).
Every febrile case (initial) may be asked to come for a follow up after 48
hours (2 days) with simple blood tests like Hb, TC, DC, ESR, platelet count
and urine routine tests or other relevant tests).or report immediately if there are
warning signs like persistent vomiting, abdominal tenderness, loss of
orientation, low BP, scarcely perceptible pulse, cold clammy extremities and
restlessness, breathing difficulty, or mucosal bleeding
(a)If patient is better, make sure that the patient is getting better in all
diagnostic parameters like BP, pulse rate, blood reports immunological
 9

parameters etc (our interpretation of perceptible amelioration).Also keep in

mind that many fevers have a biphasic stages with an afebrile period in
between malarial fevers, dengue, yellow fever.

A blood/urine/ other relevant investigations need to be done to assess the

improvement after 48 hours or it may be done earlier if the patient looks sick
than we expect in this condition, to reassess the condition/ deterioration

(b) If patient is febrile, sick, sinking vitality it means the patient has not fully
responded to our first line of treatment and hence we have to reconsider our
management strategy and so follow next critical phase management
guideline
(c) Refer to another senior homoeopathic physician or seek his advice with
whom you have confidence along with proper case details and medicine given
and decide further management

First consultation of febrile illness in critical period/ Follow up with

decreasing vitality – after 2nd day (3rd day)

Critical phase management

Eye hemorrhage
Epistaxis heat during
Mouth hemorrhage gums
Vomiting incessant
Vomiting coffee ground/ blood
Vomiting intermittent fever during
Abdomen pain liver heat during
Abdomen pain diarrhoea during
Abdomen pain vomiting after
Abdomen ascites( dropsy)
Respiration difficult mucus in the chest
Inflammation pleura
Urine bloody
Fever yellow fever
Stool bloody
Stool color black with remittent fever
Chest inflammation lungs
 10

Extremities cold diarrhoea with

Skin cold fever with, diarrhoea during
Urine scanty fever during
Tachycardia fever during
Enlargement spleen
Mind confusion, coma

Select the rubrics which fit into your case. These are crisis rubrics showing
grave character. From the list of medicines you get check symptoms you have
not repertorised. If a medicine covers all these. Then that will be the indicated
remedy

Aim - It should lessen the danger and duration of disease. It should promote
remission at the earliest and prevent complication

Step 1(a) check the prominent diagnostic and pathological

symptoms and match with the above rubrics and arrive at a group of remedies

1(b) Check for the remaining symptoms and see which remedy runs through
all of them

1(c) the expressions of masters in the literature for confirmation

Step 2(a) Medicine in low potency preferred (Q,6c,30)

2(b) Rule of repetition is the same.
Step 3 (a) The case has to be monitored every 4-6-12-24 hours
after administration of medicine. A clinical assessment is needed after 4- 6
hours assessment and decide to repeat (if the improvement is slow/feel good is
present but clinically no improvement) to wait if there is good
improvement(symptomatically and clinically) if there are signs of clinical
deterioration do appropriate investigations and assess (In dengue cases/
haemorrhagic fevers -low neutrophil count, low platelet count ,PCV Vital
signs like BP(pulse pressure), pulse rate, urine output In LRI cases respiratory
rates, breathing difficulty and Chest X Ray should be evaluated. In JE cases
orientation levels has also to be evaluated). It may be due to some maintaining
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cause which can be corrected 3 (b) by fluid, electrolyte, oxygen

administration or the medicine has to be changed. Clinical signs should be
checked as a routine twice every day Improvement assessment with relevant
investigations should be done daily to assure physician and the patient that case
is progressing satisfactorily.
Step 3(b) If vital signs show deterioration, fluids may be given as per WHO
guidelines in dengue fever/haemorrhagic fevers. Remember excessive fluid
administration has results in pulmonary oedema and ascites .IV lines nay be stopped as
BP and pulse rate becomes stable. Urine output also will have to be measured every 6
hours. Blood gas analysis is needed in case of pulmonary oedema, pneumonia etc. So
hospital administration and monitoring is to be adopted in this stage. If still patient is not
recovering then patient may be treated in High dependency units for shock
4 The patient may be referred in a medical ambulance with emergency support

First consultation at a very critical condition

Aim – to save the patient till they reach ICU

Sleep Comatose heat with

Mind dullness heat during
Face hippocratic with cold perspiration
perspiration clammy haemorrhage with
perspiration colliquative

Opium, Agaricus, Spongia, Merc, bry, hyoscyamus Carbo veg, HCN etc will come. add
the remaining symptoms of the case and find the remedy. It should correspond to the
gravity of the condition. Its use may revive the patient. Supplement whatever available
with you to help the patient and send the case to the hospital

Very critical phase management

This should be managed in hospital HDU only. But there are chances in rural settings to
get a patient in such a state.
Step 1 As usual all systemic and routine examinations should be done quickly Patient
would be drowsy, comatose, delirious or disoriented with low BP or narrow pulse
pressure , pulse may be scarcely perceptible, extremities cold and clammy
Step 2 explain the situation to patient bystanders and try to get a written consent for
managing the case and try to arrange for transportation of patient to a hospital for
critical management
Step 3 give the most indicated medicine
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Step 4 ask the patient or bystander to administer by inhaltion at frequent intervals 5-10-
15 minutes till they reach the hospital

Never deny the patient the homoeopathic care to any patient in any stage but use your
clinical
legal and common sense while dealing with such very critical cases. Advised for
referral may be written on case record even if you think it is safe for patient to undertake
our management and the patient is not illing to go to another place.
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Annexure 1

IHRC CASE RECORD FORM

Fever
Duration
1-2 days > 2 days

Part
Modalities

General upper lower side head hot &

limbs cold

Body pain

Modalities
General Neck Back Upper limb Lower limb Joints Head pain
pain (localization)
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Chill/rigor Yes No

If yes, Time

Modalities

Concomitants

Eye
Pain Yes No

If yes, modalities

Redness

Photophobia
Mouth

Coated

Dryness

Taste

Throat

Pain Yes No

Localization

Modalities
 15

Extension

Inflammation

Tonsils

Swallowing difficult

If yes, cold/warm liquids solids other modalities

Stomach

Pain Yes No

Localization

Modalities

Extension

Vomiting

If yes, Nature of Vomitus Haematemesis Modalities

Appetite

Thirst If yes, warm/ cold quantity

Thirstless
Abdomen

Enlarged Spleen

Enlarged Liver
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Diarrhoea/dysentry Nature Quantity Modalities

Urine

Anurea Albuminous Bloody Bilious

Heart

Brady cardia Tachycardia Myocarditis Hypotension

Arrhythmia

Blood

Leucopenia Leucocytosis

Skin

Petechea If yes, location

Vesicles If yes, location

Chest

Pleural effusion

Cough

If yes, nature

Modalities
(Time and other factors)
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Concomitant

Mind

Confusion Coma

Generalities
Convulsions
Other symptoms

Heart rate Added sounds

BP Resp rate
rhonchi/creps

Chest X ray

Lab investigations /date

Blood

Total count
<4000 4000-10,000 >10,000
Neutrophil

Lymphocytes

Eosinophils

Platelet count <50,000 50,000- 1,00,000 1,00,000- 1,50,000

ESR CRP

Serum bilirubin <1 mg 1-2 mg >2 mg

SGPT
<40 >40
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<1.2 <2 >2

Serum creatinine

Blood urea
<40 >40
Igm Dengue

Igm lepto

IgM chikungunya

Widal test
H O

Annexure 3
Rubric analysis of Gels in fevers

Types of fevers cerebrospinal fever (3)

Urethral fever, typhoid, eruptive, gastric, inflammatory, influenza (2)
3 mark
Heat with shivering, sweat absent, long lasting heat, chill forenoon, chill
absent, chill beginning in hands and feet, chill periodicity regular, chill up and
down the back head pain with pain in back/cervical region, extending upward,
occiput/vertex, thirst less heat during,
2 mark
Heat with chill, aversion uncovering, due to chill
Heat –summer
Head pain coryza with
Eye flushes heat during
Coryza with chillness
Thirst heat during
Waves of chill in spine
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Extremities pain chill during, coryza during, fever, influenza during

Rhus Tox Rubrics

Extremities Pain Heat

Fever during 2 With chillness, perspiration

During chill 3 Body anterior part
Continued Typhoid fever/eruptive
With scarlatina
fever,remittent fever/mrng,evng/night
Pain lower limbs with fever
Catarrhal, cerebrospinal
Getting cold
fever,peticheal,dengue,intermittent,augue,
Cold water
malaria,low fevers
Slight exertion after
Eruptive fevers – varicella, variola with
Beginning of motion
suppuration,influenza
Continued motion ameliorates
Heat with shivering/on uncovering
Left upper limbs with heart
Intermittent, chill followed by/ heat with
affection
perspiration/followed by
Weather- cold/ wet/ stormy
perspiration,chill followed by
Damp wet weather
perspiration without intervening chil, low
fevers, external chill with internal heat,
winter, zymotic
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Chill Generalities

Back part of body Agg 5-9 am,1-6pm, 9 pm- 5 am

After exposure to rain Draft of air Amelioration – open air
Frequent cold bathing Aversion/agg bathing/ cold
Becoming wet Blood pulsating with perspiration
Rigors putting hands out of bed Blood vessels- cold feeling/hot feeling heat
Chill one sided during
right side with heat of left side Change of temperature from warm to cold,
with skin pale, cold blue Getting cold, /after getting heated, agg after
getting a part of body cold, after physical
with respiratory complaints exertion, after cold water/drinks/ food,
quotidian, tertian formication cold external parts, chill during,
Tertian double Reeling gait
Lack of vital heat, lying agg/ after lying Amel
lying on back, agg lying on back
Amelioration by leaning against something hard
Inclination to lie down
Ailments after measles
Agg motion, after motion, beginning of motion
Amel continued motion, desires motion
Numbness of parts laid on,single parts,
Bryonia Rubricsaffected part
Chill Pain fibroid tissue,Heatligaments, joints, tendons
of joints, muscles
Agg/Amel
Heat evening, nightperspiration during,
midnight brfore 9 pmperspiration
Autumnal giveswith
Alternating no relief
chill
Beginning in tips of fingers and toes/lips Catarrhal Pulse- abnormal,
fever, fast continued,tyhoid
chill absent, rapid,
Exposure to wet, over heated fever,Fromintermittent,imperceptible,
taking cold weak tremulous
Agg motion, predominating chill -continuedRest Agg,physical restlessness
fever-Temperature chill during
running very
Rigors before chill,shaking chill Season agg-
high,night/before autum, winter, spring
midnight
Getting wet, Abdominal Stretch
feverfever during/
/gastric feverperspiration during
with biliousness, prone
Weather- stormy, warm to become Agg Wet weather,cold
typhoid , septic feverwind,,foggy ,cloudy
,relapsing fever,Dengue
Chillness not amel in warm room wet application,getting
fever,tertian, yellow fever,Dry heat wet
with delirium, motion,
Tertian eating after,external heat with chillness,Wants to be quiet
9 pm at any stage
Intermittent fever – irregular stages
Perspiration absent
Heat one sided/ right
chill followed by heat followed by perspiration, chill
followd by perspiration
 21

Generalities

Physical anxiety –compelled to do something no rest, hot bathing , cold bathing agg, agg change of position, desire for
change of position Agg and amel- from taking cold air, becoming cold, tendency to take cold, becoming cold agg, kicks off
covers, dryness of usually moist internal parts, agg eating small quantities
Agg from cold drinks in hot weather
Desire and amel from cold food , cold drinks
Aversion food chill during
Hot drinks desire ,aggravates
Hot food aggr
Water amel
Vital lack of heat warmth agg Heat internal, bood vessels
Becoming heated
Amel lying, on painful part
Aversion motion, aggravation motion,/ of affected part
Pulse rapid,fast, full/hard/tense
Rest amel, physical restlessness perspiration during
Season –summer , winter, in summer after cool days
Side – one side, right
Slow manifestation
Touch agg, tremblingweakness fever during, weakness exertion from
Weather wet amel, change from cold to warm, cool days after hot weather
Heat internal, bood vessels
Becoming heated
Amel lying, on painful part
Aversion motion, aggravation motion,/ of affected part
Pulse rapid,fast, full/hard/tense
Rest amel, physical restlessness perspiration during
Season –summer , winter, in summer after cool days
Side – one side, right
Slow manifestation
Touch agg, tremblingweakness fever during, weakness exertion from
Weather wet amel, change from cold to warm, cool days after hot weather

Baptisia rubrics

Chill Heat

Chill 11 am, open air, not Heat agg night,

ameliorated by warm stove Alternating with chill, continued
typhoid fever, peticheal fever, gastric,
cerebral, influenza,haemorrhagic
fever,relapsing remittent, prone to
become typhoid, septic,zymotic
 22

Generalities

Open air agg, hard bed

sensation of,
Sick feeling, lassitude,lie down
inclination to,Agg lying on painful
part,
Offensive mucous secretion,
pain sore bruised externally,
internally
Pulse rapid, hard
Restlessness physical, senses
dull,vanishing of, sensitiveness
externally, internally,Right sided,
prostrationsepticemia,
prostration fever paralytic
weakness sliding down in bed
during,trembling

Nux Vomica Rubrics

Chillness Heat

Open air agg, with chill, If uncovered, agg least draught

alternating with chill, agg of air, open air, cold air, not
motion, irregular paroxysms, ameliorated by external warmth
shivering with heat and in evening, from motion of
perspiration, chill followed by clothes, chillness with
heat followed by perspiration, perspiration, periodicity
heat followed by chill, aversion irregular, quotidian, tertian,
to uncovering in heat due to rigors, rigors agg with
chillness, in any stage of perspiration,
paroxysm, yellow fever, zymotic Time -11 am agg agg touch,
fever undressing, violent chill with
bluish mottled skin external
warmth ameliorate, desire for
warm room but does not
ameliorate
 23

Generalities

Amelioration indoor air, agg open air, intolerance of clothing, pressure of

clothing, amelioration loosening of clothing, physical anxiety, cold air agg,
becoming cold agg, part becoming cold agg, tendency to faint from odours,
with nausea, vomiting after, flatus passing amelioration, hot food amel, warm
drinks amel, cold food agg, aversion drinks, aversion food with hunger,
aversion meat, urging sensation, lack of vital heat, staggering gait, formication
cold parts, haemorrhage-dark blood, sick feeling, influenza, agg intoxication,
lassitude, inclination to lie down, physical irritability agg lying on back, amel
lying on side, amel after lying in bed, agg motion, aversion motion, mucous
secretions increased, periodicity every 28th day, perspiration gives no relief,
pulse -fluttering, rapid, small, Season winter, sensitive externally, to pain, agg
shaking head, amel sitting, tendency to sit, agg from loss of sleep, agg
morning on waking after sleep, stool amel, must stretch, stretching with
yawning, weakness, - faint like , sensitive touch, cold, weather agg cold, dry
cold amel wet agg getting feet wet

Pyrogen rubrics
Chill Heat
Beginning in back With chillness, hectic,
between scapulae, chill intense heat Celsius,
with perspiration, intermittent chronic, augue,
periodicity regular malarial, oscillating, Septic
quotidian, rigors, long fevers, stage- heat followed
lasting rigors agg by chill, aversion to covering
evening, desire for in any stage of fever
warmth which
does not relieve septic
conditions ,Time 7 pm
sewer gas`
 24

Generalities

Recurrent abcesses, becoming cold agg, Hard – bed sensation

of, lack of vital heat, influenza with chillness during heat,
motion amel, mucous secretion offensive,
Pain sore bruised externally, internally, pain motion amel,
Perspiration gives no relief, pulse rapid, discordant with temp,
fluttering, thready, irregular,
Touch- anything agg, cold agg, weakness from
perspiration,weather wet agg, Septicemia

EUPATORIUM PERF RUBRICS

GENERALITIES

Desires cold water , influenza, pain as if bones broken, sore

bruised pain, Amelioration by perspiration except headache
which is made worse, sensitiveness of bones, weakness faint
like
Cold feeling- bones, desire warm drinks- fever during, chill
during, heat vital lack of, motion agg, influenza – old people,
lying on abdomen amel, pulse –full, stretching chill before,
during trembling internally, vomiting amel

Fever

Dengue fever, vomiting agg fever during

Bilious fever, autumnal fever, influenza,, irregular paroxysms,
perspiration absent, lowbilious remittent, chill followed by heat
followed by perspiration, shivering from drinking

Chill

Chill with perspiration, drinking agg chill, predominating

chill morning- 7am-9am,
one day heavy chill ,light chill next day noon, drinking increases
chill and cause nausea, chill beginning in dorsal back, warm
drinks tolerated, warmth amelioration
 25

ARS ALB RUBRICS

GENERALITIES

Amel open air, anxiety physical, agg ascending, amel warm

bathing, cold feeling blood vessels, change of temp , to cold,
becoming cold, fainting tendency- motion from, haematmesis,
vomiting, desires cold drinks, amel warm drinks, food,
flushes of heat, as if warm water poured over one, vital lack
of heat, inclination to lie down, agg lying after,/ with head
low,amel lying with head high, agg motion, aversion motion,
amel violent motion, agg newmoon, fullmoon and waxing
moon, pain burning, neuralgic, pressing tearing, stitching
type, periodicity every fourteenth day, perspiration gives no
relief, Pulse abnormal, small , rapid and small, irregular,
weak, rising up amel, running agg, Season winter, sit with
knees drawn up with hands and head resting on knees,
standing amel, side right side, agg before during, first sleep,
waking from sleep, stretching with yawning, trembling from
anxiety, warmth amel, weakness- eating after, exertion,
diarrhoea, vomiting, fever during, with restlessness, from
pain, weather cold wet, getting wet- sitting on damp ground,
damp wet room

Chill

Open air agg, day- fourteenth day, periodicity, quartran,

quotidian, tertian, irregular periodicity, chill with respiratory
complaints, rigors while walking in open air, time- 1am , 2am,
3am, 1-2 pm, warmth amel

Fever

Heat with chillness morning, heat without thirst night, heat

with anxiety, night, heat alternating with chillness, heat
outside cold inside, blood seems to burn in veins, burning
heat with unquenchable thirst, chill absent- 1-2 am, midnight,
2am 3am , continued ,typhoid fever, peticheal fever with
extreme prostration, brown dry leathery tongue, putrid
cadaveric stool, hectic fever with delirium, gastric fever,
stages irregular, one stage wanting, chill followed by heat
followed by sweating, yellow fever, zymotic fever, septic fever
 26

Arnica rubrics

fever Heat of upper part of body, heat with chillness ,burning

spots which feel cold to touch, continued fever- peticheal/with
foul breath ,says there is nothing matter with him, coughing
increases heat,
Intense heat, heat of head and face with body cold, fever with
shivering, shivering< uncovering, desire for uncovering, motion
, chillness
Stages- chill followed by heat, zymotic fever, yellow fever, fever<
during vomiting

Chill

Chill beginning in pit of stomach, agg motion, slightest motion of

bed clothes, chillness of lower part of body, violent congestion
of head, cold body with thirst and chill most severely felt in
pit of stomach body feels bruised, undressing agg, shaking
rigors with heat of head, chill 4 am chill one sided, quartan,
quotidian, chill agg 6 am, violent chill with delerium

Generalities
Indoor air agg, desire for open air, cold washing amel, bcoming
cold agg, physical exertion agg, faintness fever during , flushes
of heat, agg becoming heated, formication cold external parts,
hard bed sensation of, excessive physical irritability, pulse-
full rapid fluttering, jerking

Opium
Generalities
Activity- desire, increased
Bathing – warm bathing agg
hard bed sensation of
Numbness chill during
agg during perspiration, no relief - perspiration
Generalities – ailments from – excitement, fear, fright
Pulse- rapid, slow, abnormal, imperceptible,full,irregular
Septicemia,
Sensation of strength
Ailments from sun desire uncovering, hot weather agg, walking
desires
 27

Fever
Type – continued , septicemia, cerebrospinal,
intermittent
Body – lower part
Stuporous, stupefaction and unconsciousness
Delirious
Intense heat of head and face, body cold
chill followed by heat with perspiration
desire for uncovering

Chill

Shaking, rigor during stuporous sleep

Pulsatilla-Rubrics
Types of fever – zygotic, septic, rheumatic, puerperal, milk
Fever
fever, continued typhoid, catarrhal, tertian, remittent,
intermittent, bilious, gastric, and hectic
Side – one sided, right side,

With chill between 2-4 pm

With dry heat, with perspiration
Burning heat- evening night in bed –with distended blood
vessels, burning hand seeks out cool places
Changing paroxysms, no two paroxysms alike
Paroxysms increasing in severity, irregular, long chill,
little heat, no thirst
Intense heat with delirium

Heat followed by perspiration, chill followed by heat

followed by perspiration

Warmth, warm room agg, aversion uncovering, desire

uncovering, washing amel
Uncovering amel, walking in open air amel
 28

Preventive Medicine–Genus Epidemicus - RAECH-

Guidelines

In Kerala IHMA is participating in the first ever public private homoeopathic venture
in our country in preventive field called RAECH( rapid action epidemic control cell
homoeopathy). From it time of evolution via G O (rt) no 2543/04/H&FWD dated
7/9/2004 it has become an umbrella where epidemic related measures and studies are
conducted in homoeopathic field. It is striving for a standardized quick and effective
response in epidemics. Though many of us may point many fingers at the functioning
of this system, it is undeniably true that
1) It had created a group thinking in epidemic situation where chaos was in the state
where each organization would declare and criticize the genus epidemicus of other
organizations and created confusion in the minds of the people
2) It had brought out scientific studies on the effectiveness of prophylactic medicines
which gave us a talking platform among scientists. This was possible only because of
manpower and money resources pooled by RAECH which could not have been done
by other organizations

Any mass programme needs multi level participation and so is our preventive
programme. Rather than a homoeopathic programme run by homoeopaths for
homoeopathy it has to be a people’s programme guided by homoeopathic experts.
More expertise, more standardization, more alertness and more multilevel involvement
of experts and voluntary organizations is needed in delivery of medicines at shortest
notice, planning the delivery , increasing rate of consumption of GE, and feedback
study. But the core area, identifying GE with standardization is of greatest concern
and all IHMA members participating in RAECH activities or interested in preventive
field of homoeopathy are requested to keep in mind the following points

In an epidemic the most used and effective medicine in treating the epidemic case
may not be the preventive medicine. This is a wrong concept harboured by many
professionals.

In scarlet fever epidemic where Belladonna was selected as the GE by Hahnemann

(the first genus epidemicus), but ipecac and opium were the most frequently used
medicines by Hahnemann.

Totality of GE – should be the totality of the initial symptoms of the disease.

Belladonna effectively covered the initial symptoms of the scarlet fever and hence was
selected as the GE for scarlet fever. Ipecac and opium were most frequently used by
 29

Hahnemann as the patients came to him a advanced stages but these medicines have no
role in preventing the initial symptoms from developing to a full fledged disease.
Test of effectiveness of a GE- it should not only prevent the disease but when
administered in the initial stage of the disease should abort the disease. That is the only
test suggested in our literature.
Case taking for selecting GE – Should possibly be taken from the epicenter of the
epidemic and should include all the symptoms in detail. Case taking need not be taken
in complicated cases /ICU’s.
Relation with RAECH- any person can take the case reported before him and
report it to the DLEG member or can contact the nearest medical officer. Please
make available with you a contact /phone number of the medical officer/ DLEG /TRG
member. You will be invited to the DLEG to present the case or more wide case taking
in your area may happen. please follow it up with your DLEG member on the progress
of the epidemic management.

PLEASE HELP TO UNDO THE FALSE INTERPRETATION THAT CASES

ARE TAKEN AT THE LOCAL SETTINGS AND MEDICINES ARE DECIDED
BY SLEG IN THIRUVANANTHAPURAM. DECISIONS ARE TAKEN AT
DISTRICT LEVEL AND REPORTED TO SLEG WHICH RATIFIES IT OR SEND
BACK FOR RECONSIDERATION.

Contact the SLEG member if you have any complaints or suggestions to be made
before the highest level
Camps- you can organize medical camps in association with RAECH after informing
your DLEG member who in turn will notify the DMO and medicines will be made
available to you as per DLEG decisions. Now the medicines are distributed in strip
forms and it is readily available in HOMCO at shortest notice.

If you have any influence in media or in organizations which can help deliver the GE
please report it to your DLEG member

Together we fight together we win