Leprosy is a disease of global concern not only because of its potential to affect large number of people and its continued transmission but also because of the occurrence of deformities in a great proportion of patients. It is also a fact that multi-drug regimen has been effective in killing Mycobacterium leprae resulting in control of infection in leprosy patients ,but it has no impact on associated disability due to nerve function impairment and trophic ulcer in leprosy though the patients are declared cured on the basis of absence of pathogens in the host and absence of granuloma in tissue.

Homoeopathy creates a niche here to explore the other means of treatment to save the leprosy patient from disability, provided we learn to translate effectively the Hahnemannian Miasmatic approach to the patient in suppressed susceptibility who presents with paucity of symptoms and poor reactivity to homoeopathic medication.

Keywords:leprosy,MDT,lepra reactions,MDR cases,neuropathic ulcer,homeopathic intervention

INTRODUCTION Leprosy is a disease of global concern not only because of its

potential to affect large number of people and its continued transmission but also because of the occurrence of deformities in a great proportion of patients. It is also a fact that multi-drug regimen has been effective in killing Mycobacterium leprae resulting in control of infection in leprosy patients ,but it has no impact on associated disability due to nerve function impairment and trophic ulcer in leprosy. Among all disabilities, leprosy contributes 15 –20% disables. Thus, leprosy is a disease not only of public health importance but has got tremendous socio-economic implication.

In WHO recommended Multi Drug Therapy (MDT) regime, patients are treated on detection of leprosy. The aim of this treatment, however, confines to kill the pathogens and to check the infection.The patients are declared cured on the basis of absence of pathogens in the host and absence of granuloma in tissue.

However, even after released from treatment (RFT), the patients suffer from neuropathy, loss of pigmentation, ulcer and other secondary complications for rest of their life. In many cases after completion of MDT, the patients become AFB negative, but the bacteria remain in dormant stage in skin, nerve and in certain other locations like dartos muscle which can cause relapse of the disease.

Bacterial resistance with consequent clinical inefficacy, clinical improvement with no corresponding bacterial improvement, precipitation of Lepra reactions of severe type drug toxicity and sensitization reactions of varying severity are the problems with MDT ,Lepra reactions pose a serious problem; some patient need hospitalization for effective management. Recurrences are frequent, making patient-acceptance low.

Newer, more potent medications pose the problem of costs: Clofazoimine is 30 times while Rifampicine is 90 times more costly than Dapsone. Greater potency against Lepra germs also parallels greater toxicity for vital organs like the Liver, Kidney, Bone-marrow Brain and Nerves. These reactions render the drug unsuitable for many patients.

Then again, these drugs, in no way improves the ability of the patient to fight the germs of Leprosy. That is a general drawback of all Chemotherapy and Antibiotic Therapy.All this indicates the need for an effective alternative to the problem of the Management of Leprosy. Needless to say that it is both an opportunity as well as an obligation on part of the homeopaths to offer their gentler branch of medicine of proven safety and effectiveness as an additional means of managing the leprosy cases especially the Multi Drug Resistant(MDR) cases,which may be apart of bioterrorism attack. It may be pertinent to point out that the natural evolution or weaponization of the biological pathogens often involves alteration of their microbial genome to enhance their virulence to render conventional medicines ineffective in many cases.

As selection of homeopathic medicines is based on total symptom picture, it is imperative to acquaint the patients and public at large with preventive and curative aspects of homeopathic system of medicine.

Homoeopathy creates a niche here to explore the other means of treatment to save the leprosy patient from disability, provided we learn to translate effectively, the Hahnemannian Miasmatic Approach to the patient in suppressed susceptibility, who presents with paucity of symptoms and poor reactivity to homoeopathic medication. Clinical improvement is seen with restoration of susceptibility through combining with the anti-miasmatic remedy based on the presenting totality, the inter-current remedy in frequent doses .

We are able to do it. Hahnemann stands vindicated!

THERAPEUTIC AIM

• To treat symptomatically• To retard disease progress • To reduce the lepra reactions• To attain maximum functional power

MEDICAL TREATMENT• INTERCURRENT

– Sulphur– Thuja– Tuberculinum

• SYMPTOMATIC– Calotropis– Chaulmoogra oil– Elaeis– Hura– Hydrocotyle– Piper methysticum

• CONTRACTURES/PARALYSIS– Causticum– Curare– Plumbum metallicum– Thallium

• TROPHIC ULCERS– Anacardium occidentale– Kalium bichromicum– Thallium

• LEPRA REACTIONS– Apis– Arsenicum album– Belladonna– Mercurius solubilis– Rhus toxicodendron

COMPILED BY:Dr. Neena Mehan (Reader NFSG

Sur Homoepathic Medical College and Hospital, IP University)