Friday, March 23, 2012

An Amazing Philosophic and Spiritual Approach to Homeopathy-

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While studying and reading some philosophy and spiritual books, came across a wonderful simile between spirituality and homeopathy. Herewith I will try to elaborate it as per my capability.

Swami Vivekananda depicts this wonderful doctrine of imbalance of life on this earth. This world is said to be existing because of various imbalances that surround within us and outside us. “Lost Balance” is what makes the world what it is. The formative forces of the universe come close through struggle, competition, and conflict. Suppose that all the particles of matter were held in perfect equilibrium, would there be any process of creation? We know from science that it is impossible. Just disturb a sheet of water and there you find every particle of the water trying to become calm again; one rushing against another. And in the same manner, all the phenomena which we call the universe- all things therein- are struggling to get back to the state of perfect balance. Again a disturbance comes and again we have combination and creation. “INEQUALITY IS THE VERY BASIS OF CREATION”. At the same time, the forces struggling to obtain equality are as much a necessity of creation as those which destroy it.

The millennium of perfect equality will come only when the cycle of creation comes to its end.

Shortly, the good and evil are the two sides of the same coin. They are distributed in the world to create desires and the ultimate desire to turn away from those desires. Through this turmoil arises the work or karma!

The different philosophic schools, different religions preach the very lessons differently. When through any school of thought, we try to attain equality, we are going towards freedom. The very reason for human existence is to attain freedom. And through positives and negatives of our works, we are propagating on its path, as spiritual beings through ages.

When this equality is attained, there lies the liberation. This is nothing but PERFECTION. And when perfection is ensued, we attain what is termed as ultimate BLISS.

Now how this depiction comes close to homeopathy?

As we all know, the past history, birth history, and even pre-birth history is very crucial while dealing with any case homeopathically. And we try to match the picture of the drug with the picture of the patient. When there is partial similarity in a certain case, we get only partial results and the patient is not cured completely. That means we haven’t ensured the state of equilibrium yet. To attain equilibrium, the picture of the drug has to match completely with that of the patient. There remains no space for disharmony between the two. The miasmatic overload has to be studied. This complete match is nothing but attaining simillimum in homeopathy. Through the practice of homeopathy, many of us know that unless this simillimum is attained in any given case, we cannot cure a patient completely. And CURE is nothing but the state of BLISS in that person’s life who is suffering incessantly from various maladies.

In short, “Similia Similibus Curentur” is one of the best possible metaphors to the world’s nature of imbalances and balances that try to attain equilibrium. After all, EQUILIBRIUM or HOMEOSTASIS is the ultimate bliss, be it on spiritual plane or physical and mental plane! 

Friday, March 9, 2012

Homeopathic Fever Therapeutics Unveiled!

{For health queries, mail to-}

Yes! Fevers can be Treated Homeopathically!

When I started my homeopathic practice first, obviously the most patients that used to visit me were for acute diseases. I was a novice, very enthusiastic about my practice, and with a kind of ‘know-all’ feeling that every doctor has when he first starts his practice. I had attended the best doctors’ OPDs, had attended several indoor as well as outdoor patients where I was working as a houseman, and my teachers had happily bid me adieu saying now I was capable of independent practice. I had believed their word and started with all the necessary enthusiasm (and minimal possible investmentJ). But when I began, literally every patient used to make me think several times- did I do it right? When the next time patient used to give positive report, I used to feel good, and of course when he would nod in negation, I was nervously restless.

I do remember that this nervous restlessness was commoner for acute cases than for chronics. Chronic cases give you lot of time to think and act accordingly. Acute cases are obviously in hurry and need you to employ your brain to work as fast as you can. Your every mistake punches you in face and you start taking acute prescription far more seriously than chronic. The commonest health problem that used to punch me in face was FEVER!

Always I hated any kind of anti-pyretic and more I used to hate, more my patients used to take it, as my medicine failed to yield positive result. This is not done! I used to warn myself. Why the hell I can’t treat a simple condition like fever and if this is so, what credit should I take for curing eczemas and asthmas? With this thought I started studying more and here is the result of that study.

The foreword however is- a homeopath or a student of homeopathy needs to see lots and lots of cases of fever in order to master them. We as students or even as practitioners used to request our elder teachers to allow us visiting the indoor patients even after our college life was over. We used to go, check every patient, take case in details, and discuss with our professors how we can proceed with the case. There is no short cut to learn fevers or anything for that matter.

Also as much you need to know fevers homeopathically, you should also know them clinically. You should be aware of –
-         the types of the fevers,
-         their varied manifestations,
-         common symptoms of the fever patients,
-         differential diagnosis of severe fevers
-         other vital parameters like pulse that show different changes in various types of fevers etc

Without going into these details, however, we will go straight to the homeopathic differentiation of the fevers. As I said you must know the common symptoms of fever so that you can pin point the characteristic symptoms in an individual fever patient to treat homeopathically.

Let’s first list the most useful homeopathic drugs for fevers.

The List of Important Fever Drugs-

1. Aconite
2. Apis mellifica
3. Antim tart
4. Arnica
5. Ars alb
6. Belladona
7. Bryonia
8. Cactus
9. Chin-sulph
10. China
11. Baptisia
12. Dulcamara
13. Eup perf
14. Ferrum phos
15. Gelsemium
16. Hepar sulph
17. Ipecac
18. Mercurius
19. Natrum mur
20. Nux vomica
21. Phosphorus
22. Podophyllum
23. Pulsatilla
24. Rhus tox

So, these are the important fever drugs. And if you want to successfully treat fevers (more aptly patients with fevers), you need to master at least these 24 drugs. Sounds difficult? Nope, we will make it easy for you!

Let’s list the prime-most and characteristic signs and symptoms of the above drugs so that you can match these symptoms with those of the patient and treat accordingly. We will also see what symptoms call for and what symptoms don’t call for the particular remedy; so it is easier to comprehend the difference.

1. Aconite-
1)     Sudden and violent fevers without the actually inflammatory pathology cal for Aconite. So, give it when the patient develops acute fever suddenly without any predisposed conditions like sore throat, cold, cough, etc.
2)     Dry and cold weather usually bring on such acute paroxysms.
3)     You can see the patient absolutely restless, anxious, and walking to and fro the hallway in sheer restlessness.
4)     Aconite is almost never called for in fevers without restlessness.
5)     Feeling as if a cold wave passes through him is a hallmark of Aconite chill stage, which is very marked.
6)     Marked thirst and nausea accompany
7)     Every food tastes bitter, so doesn’t want to eat. But water does not taste bitter, so keeps drinking water continuously.
8)     The parts, on which he lies, are drenched in sweat after the heat stage. And once sweat sets in, he feels good.

2. Apis mellifica-
1)     Many kinds of allergic fevers call for Apis mellifica.
2)     The fever might result from bee stings or excess heat in summers
3)     Typical red rosy hue of the patient is the marked feature with suffused conjunctivae
4)     Fevers in acute kidney infections many times fall under Apis, associated with puffiness of the body and face
5)     General soreness of the body in fevers, as in Arnica, is marked. But Arnica often says there is nothing the matter with him; and Apis will be totally down with fever, hard to please!
6)     Apis is often indicated in chills that start in the afternoon, associated with thirst.
7)     Feels suffocated during heat paroxysm.
8)     Once the sweat sets in, the patient is extremely sleepy; rather sleeps after the fever paroxysm.
9)     Post-fever rash is one of the major domains of Apis.
10) Of course as we know Apis is always worse by heat and better by cold applications. Craves for cold applications in fever!

3. Antim tart-
1)     Fevers almost always preceded by respiratory problems like colds and coughs.
2)     Fevers and respiratory problems emerge many times from consuming raw sour fruits, especially in children.
3)     Fevers characterized by marked drowsiness, sweat, and prostration.
4)     Thick white coating on tongue with red edges; often dry in the center
5)     Severe chest congestion with loads of slimy sticky mucus that is hard to cough up
6)     Fevers with trembling of the whole body and chilliness (despite being a hot remedy in general)
7)     All three stages in fever are marked
8)     Once the sweat sets in, patient feels faint and sleeps.
9)     Extreme lethargy with intermittent fevers, many times with Pustular eruptions
10) Damp cold weathers and evenings aggravate

4. Arnica-
1)     Many times, if there is extreme soreness of the whole body with typhoid fevers, Arnica is the remedy indicated.
2)     Fevers due to abscesses that do not mature calls for this remedy
3)     Deathly coldness of extremities during fevers
4)     Marked shivering of the whole body with heat and redness in face
5)     Sour sweats at night after meals
6)     Doesn’t like to talk to people in fevers, hates people approaching him for asking about his health. He will never answer affirmatively regarding his suffering. Will say there is nothing the matter with him but inside great nervousness and pain
7)     Worse by least touch and better by ling down with head bit low

5. Arsenicum album-
1)     You can think of Arsenicum album if the patient is prostrated out of proportion to the fevers. May be the patient is having low to moderate degree fevers just for 1-2 days and feel as if he is having fevers chronically that drain him out.
2)     Many times periodical fevers call for Ars alb; like- fevers that recur every night or alternate nights
3)     Fear, restlessness, and anxiety are the trio of Arsenic alb without which we shouldn’t give this remedy.
4)     High temperatures with septic fevers
5)     In cases of typhoid fevers, think of Aconite in bit later stages, may be after Rhus tox
6)     If the patient has marked heat about 3 am, your drug surely is Arsenicum album, especially if associated with marked thirst for sips of water
7)     Aggravated by cold drinks or cold food, better always by warm drinks and warmth

6. Belladona-
1)     Think of Belladona as a remedy in fever when the patient complains of sore throat prior to developing fevers. On examination, the throat is bright red with swollen yet healthy tonsils and marked pharyngitis
2)     Marked dryness of mouth with fevers
3)     Heat, redness, throbbing headaches, and aversion to water are the characteristics of Belladona fevers
4)     Violence of attack with suddenness of symptoms mark Belladona fevers
5)     Delirious fevers many times call for Belladona with the above symptoms
6)     Delirium in fevers with icy cold feet
7)     Head sweats
8)     No thirst during fever is a characteristic symptom
9)     In children Belladona os often indicated in fevers. Child that is hyperactive even during fever often calls for Belladona

7. Bryonia-
1)     Fevers during change of weathers many times call for Bryonia
2)     Fevers that are often associated with dry cough
3)     Don’t forget the characteristic pulse of Bryonia patient in fever
4)     External coldness with marked internal heat is the key note symptom
5)     Fever associated with  stiffness of back and chest region
6)     The stitching pains in various muscles, ligaments, etc with dryness of mucus membranes
7)     Bitter taste in mouth and excessive thirst is the hallmark of Bryonia in fevers
8)     Marked increase in the irritability of the patient during fever
9)     Even in midst of high fevers, thinks and talks of business- now that’s typical Bryonia!
10) Often it is found that the existing constipation tendency is enhanced during fevers of Bryonia patient
11) Of course he is better by complete rest!

8. Cactus-
1)     Here is one comparatively less-talked about remedy for fevers. But for periodical intermittent fevers that occur every day at the same hour necessitate the use of cactus in some cases.
2)     Incomplete stages of fevers, neither there is full-blown chill, nor heat or sweat.
3)     Subnormal temperatures that just remain static for long time without any reduction
4)     Midday fevers around 11 am and if the stages are incomplete, often accompanied by hemorrhages
5)     Otherwise cold sweating predominates
6)     Great anguish is a concomitant many times

9. China sulph-
1)     If a malarial fever is suppressed, many times a dose of China sulph is said to bring back the suppressed paroxysm.
2)     Marked periodicity in symptoms
3)     Chronic nephritis associated with subnormal temperatures also call for this remedy with sudden anemic spells
4)     Chill spell daily occurs at 3 pm
5)     One of the characteristic symptoms to observe during chill stage is occurrence of painful swelling of various veins during a chill.
6)     Extreme shivering even in a warm room
7)     Subnormal temperatures with marked anxiety
8)     Sometime skin eruptions like urticaria precede or follow fevers in China sulph

10. China-
1)     Often the weekly fevers that have all the stages very marked are cleared by China
2)     Debility is the hallmark of China fever.
3)     Another noted symptom in practice is sweating on single parts that are caused by very little exertion.
4)     Fever many times associated with nightly coryza, watery discharge, pain in temporal region
5)     Anticipates the onset of fever- is a very marked symptom in almost all patients of China.
6)     Chill many times begin in breast area, markedly so in the forenoon.
7)     Not called for in acute fevers mostly. Rather any diseases in earlier stages don’t call for China. It is an established case with prostration.
8)     Almost always associated with marked bloating of abdomen.
9)     Night aggravations are common and the patient is better in open air

11. Baptisia-
1)     Indicated in septic fevers like typhoid, malaria
2)     Extreme prostration
3)     Many times can be used successfully in epidemic influenza too
4)     Marked symptom is- chill brings on the rheumatic pains and soreness all over the body
5)     Occasional chills with marked heat stage calls for Baptisia
6)     Chill about 11 am like in cactus but cactus has its definite set of symptoms that Baptisia does not have.
7)     Worse in humid atmosphere is the hallmark of Baptisia.
8)     Also worse in foggy weather and indoors.

12. Dulcamara-
1)     Causative factor of exposure to cold, rains, etc is very important to assess before giving Dulcamara
2)     Icy coldness of the body with pains all over characterize Dulc
3)     Dry burning heat all over with chills in the evening
4)     Chills felt more in back
5)     Many times the fever is associated with cold cough with free expectoration.
6)     Cough after physical exertion may end up in fever.
7)     Worse by damp cold, rains, and always better by warmth in general

13. Eupatorium perf-
1)     In malarial and influenza fevers, bone pains characterize Eup perf.
2)     Marked periodicity is observed in fevers, as in Ars alb, China, etc.
3)     Morning chills about 7 to 9 am call for this remedy many times
4)     Chill is always preceded by great thirst and aching of bones
5)     Deep bone pains +++
6)     Fever almost always associated with nausea and bilious vomiting.
7)     Extreme and insatiable thirst which makes him realize that the chill is coming. So, thirst acts like an anticipatory sign in this remedy.
8)     Throbbing headache is the most dreaded concomitant.
9)     Once he starts perspiring, the bone pains lessen, he feels good but the headache continues still!
10) The patient is better when conversing with others. Perhaps this means, distraction from his complaints by talking with others makes him feel good.

14. Ferrum phos
1)     The best suggestion on the use of Ferrum phos is mentioned by Boericke. He says, “It (Ferrum phos) stands midway between the sthenic activity of Aconite and Belladona, and the asthenic sluggishness and torpidity of Gelsemium.
2)     False plethora is what you should look for in a ferrum phos subject, which is often mistaken for a robust constitution.
3)     The anxious restlessness does not call for Ferrum phos; the patient’s face is more active than that in Gels
4)     Mostly indicated in the first stage of fevers
5)     Many times fever is associated with or preceded by catarrhal affections of the respiratory tract
6)     Chills at 1 pm is the hallmark but even if it is not found, you can very well use Ferrum phos with above set of symptoms in early stages of fevers
7)     Patient however feels worse at night

15. Gelsemium
1)     Must present in Gels- Dullness, dizziness, drowsiness, and trembling
2)     Sensitive people that develop fevers at the falling temperatures many times cal for Gelsemium
3)     General prostration
4)     Influenza with marked sleepiness; cannot keep her eyes open
5)     Dusky hue of the face during fevers
6)     Violent shaking during chills; has to be held tight
7)     Chills traveling up and down the back—very important symptom often verified in practice
8)     Long and literally exhausting heat and sweat stages
9)     Tension headaches and giddiness often accompany
10) Thirstless patients mostly; especially the chills are always without thirst
11) Aggravated in foggy wet weather and better in open air and by stimulants.

16. Hepar sulph
1)     Infective fevers resulting due to boils, abscesses, etc call for this homeopathic antibiotic- Hepar sulph
2)     Infective sinusitis with fevers
3)     Extreme hypersensitivity to colds; just cannot tolerate fan or air conditioning
4)     During fevers the part that he lies on becomes painful
5)     Slightest winds bring on the fevers
6)     Usually indicated after the Belladona stage of fevers
7)     Dry heat at night characterize it
8)     Followed by profuse, sour, offensive, and sticky sweat
9)     Better by wrapping head up and warmth in any form

17. Ipecac
1)     Fevers associated with persistent nausea and vomiting
2)     With clean tongue!
3)     Irregularly occurring pyrexia with history of malaria treated with quinine
4)     Chill stage not very marked but followed by a long heat stage with high temperatures
5)     Many times fever associated with breathlessness and cough
6)     Patient complains that whenever he takes some improper diet, the fever relapses.
7)     Worse periodically and by moist warm winds

18. Mercurius
1)     Syphilitic, putrid fevers with excessively offensive discharges
2)     Gastric or bilious problems resulting in fevers call for Mercurius
3)     Slow and lingering debility since many weeks or months after the fevers
4)     Alternate heat and shuddering with chills
5)     Chills creep through the body more in the evening into the nights
6)     Yellow, non-relieving perspirations that smells really bad
7)     Alternate flashes of heat in different parts of the body is the hallmark of Merc
8)     Worse in night, damp weather, extremes of temperatures, warmth in any form

19. Natrum mur
1)     Continued chilliness that is not ameliorated is the chief guiding symptom of Natrum mur
2)     Chill between 9 to 11 am is another characteristic
3)     Heat stage very marked with high temperatures and violent thirst that increases with the increase in temperature
4)     Fever blisters are one of the hallmarks of Natrum mur. They may accompany fever or result as a consequence of fevers
5)     Sweating marked on face, above lips, on slightest exertion
6)     Excessive weakness, constipation, and lack of appetite are the major concomitants
7)     Almost always associated with awful headache that increases as the day advances
8)     Worse by talking, warm room, etc and is better in open air

20. Nux vomica
1)     Cold stage is the most prominent stage in Nux vomica
2)     He senses in the morning after a bad night that he is going to develop fever; so is the chilliness
3)     Very bad rigors; so much so that the fingernails turn blue
4)     Associated often with pain in back and limbs, with gastric derangement
5)     The chills are so marked that even after he enters heat stage or sweat stage, he has to keep himself covered. Must be covered in every stage of fever
6)     Or there might be another case where he feels chilly but doesn’t want to be covered; in both cases, look for Nux vomica as the simillimum by matching other symptoms
7)     In the second type, usually there is extreme dry heat of the body
8)     Worse mental exertion, debauchery, alcohol, cold. Better by a nap but has to finish it completely!

21. Phosphorus
1)     Hemorrhagic fevers come under the realm of Phosphorus usually
2)     Extreme weakness in sensitive and bony patients
3)     Chilliness marked in the evenings
4)     Fevers associated with lack of thirst but unnatural increase in appetite
5)     Profuse perspiration follows at night
6)     When temperatures rise, the patient may develop epistaxis (nose-bleed) and bloody stools at times
7)     Hemorrhagic spots on the body may develop
8)     Aggravated in twilight and change of weather; better by cold food and drinks, sleep, and open air

22. Podophyllum
1)     Extreme talkativeness during fevers is the hallmark of Podophyllum
2)     Chill that begins in the early morning around 7 am brings on a mild dull pain in the hypochondrial region
3)     Pains start in all the joints, knees, wrists, ankles, etc
4)     Profuse sweats are also there
5)     May be accompanied by preceded by abdominal colic and loose stools
6)     Thus Podophyllum is worse in the early mornings and in hot weathers

23. Pulsatilla
1)     Again as in Nux vomica, chill stage predominates in Pulsatilla. However, you can of course understand the obvious difference between the two constitutions
2)     Chilliness even in warm room
3)     As the body pains increase, so does the chilliness
4)     Wandering pains in the body
5)     Chill at about 4 pm with continued temperatures in the evenings
6)     As the night approaches, the burning heat increases with distended veins
7)     Despite chilliness, external heat is intolerable
8)     Completely thirstless during fevers too
9)     When the temperatures recede, headache, diarrhea, nausea, and loss of appetite ensue
10) Worse by fatty rich food, towards evening; better in open air and slow walking around

24. Rhus tox
1)     Suitable in many cases of typhoid fevers with dry brown tongue with red tip
2)     Great restlessness is always a concomitant of Rhus tox fevers
3)     Fevers in wet raining weathers or having a head bath
4)     Fevers associated with loose stools, trembling, and dry cough many times
5)     Feels chilly suddenly as if cold water is being poured upon him
6)     During the heat stage, urticarial rash develops that itches intensely
7)     Chills followed by heat and the patient in heat stage feels like stretching his limbs continuously that makes him feel better
8)     Better by frequent change of position, worse during rest

Tuesday, March 6, 2012

Pre-Menstrual Syndrome (PMS) - What is it? How to Deal with PMS Homeopathically?

{For health queries, mail to-} 

Woman! A mysterious creation of God, a wife, a mother, a caretaker of the family, a business-woman, and a multi-tasking persona! Well, with all that complimentary thoughts about a woman, we also know that she is the one that caters so many responsibilities that are hard to count. No, I am not talking about her responsibilities of family or surroundings. I am talking about her responsibilities on health ground, pertaining to her body. So many milestones to cross in a single birth! Menarche, pregnancy, lactation, child-rearing, menopause, etc to name a few… Pre-menstrual syndrome is another nasty milestone if she doesn’t care for her health properly. Yeah, all milestones are not enjoyable, isn’t it?

So, this pre-menstrual syndrome, as the name suggests is the period in a woman’s life before her normal menses. I mean, if the pre-menstrual days bring her some sort of trouble, it is termed as syndrome or simply PMS.

Definition of PMS-

If we need to scientifically define PMS, we can say that it is a combination of woman’s emotional, physical, and psychological disturbances that occur after her ovulation and last till the onset of her menses.

Startlingly enough, about 80% of women population suffer some form or the other of PMS. Or we can say the hormones rule them to some extent making their life miserable to variable degrees. (Though the exact cause is not known, it is believed to be due to some weird interaction between androgenic hormones and neurotransmitters in the brain).

Clinical Features of PMS-

  1. Mental and Emotional Symptoms-
·         Excess irritability
·         Depression
·         Loathing of life,
·         Lack of desire to work,
·         Hyper-sensitivity to every stimulus,
·         Crying,
·         Anxiety,
·         Excessive stress, etc.
  1. Physical symptoms-
·         Breast tenderness (mastalgia)
·         Excess fatigue
·         Acne
·         Changes on bowel habit
·         Absurd food cravings or aversions
·         Flatulence and bloating of abdomen, etc

In rare cases, a severe form of PMS is observed that is termed as Late Luteal-Phase Dysphoric Disorder or Pre-menstrual dysphoric disorder (PMDD). In this form the mental symptoms are often exaggerated that necessitate emergency measures at times.

Treating PMS-

Many times, the woman is unaware that she is suffering from PMS, unless there are marked physical symptoms like breast tenderness. However, questioning properly pertaining to her pre-menstrual phase gives the doctor a good clue about her PMS status. Foremost job of a doctor is to assure her that this can be tackled medically and with certain lifestyle changes. Most women fear of having some grave condition because of which they are facing such trouble every month.

Certainly the woman should also be checked well for any signs of pallor or other deficiencies, as these can only ad to the problem. Also her blood pressure should be monitored regularly in order to see any periodical upswing in the readings before menses. For a homeopath, all these factors and many other characteristic factors are important to consider before he or she begins thinking about the line of treatment.

Though the research says that there is little relation between personality types and PMS, I have often found that type A personalities often face kind of severe form of PMS than those with more relaxed approach. Therefore, digging deep to reveal the basic constitution in the patient is very much necessary to know the root cause of the problem.

The typical signs and symptoms that differ from woman to woman pre-menstrually are important to consider for treating that woman homeopathically. Many different homeopathic remedies are found to be useful for treating PMS. Rather, it is one of the best therapies that lessen the pre-menstrual problems for a woman, while balancing her disordered hormonal harmony. There are remedies like Natrum mur, Belladona, Magnesium phosphoricum, Bryonia, Ammonium carb, Nux vomica, Platina, Ambra grisea, Sepia, Ferrum phos, Asterias rubens, and many more that have specified symptoms. The homeopathic physician needs to match these drug-symptoms to the symptoms of the patient and treat her accordingly. To cure PMS permanently, one must have the constitutional approach to help the woman improve her health on all planes while relieving her of PMS.

Auxiliary Regimen-

Certain lifestyle changes are very much necessary for the PMS sufferers. They must not indulge too much in oily, fried food, especially prior to menses. This is the finding I often see in my practice. If the woman avoids eating excessively fried and junk food items at least 8 to 10 days prior to her next menstrual date, her PMS symptoms are less pronounced. Of course avoiding them completely makes things much better for her! Sedentary habits are also known to suffer from PMS symptoms more. So, get moving. Nothing can make your hormones work in a synchronizing way with your bodily needs as a good exercise. As always yoga helps a lot in controlling the mental and emotional symptoms of the woman and gives her added compliance when on homeopathy. The last but not the least, drink adequate water! Yes, it’s must!