HOMOEOPATHIC APPROACH OF GALL BLADDER AFFECTION INCLUDES GALL STONE COLIC
BY
DR. PAWAN S. CHANDAK
Parbhani, Maharashtra
pavanchandak498@gmail.com
Gall Stone – General Medical Consideration:
In medicine, gallstones (choleliths) are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components.
Gallstones can occur anywhere within the biliary tree, including the gallbladder and the common bile duct. Obstruction of the common bile duct is choledocholithiasis; obstruction of the biliary tree can cause jaundice; obstruction of the outlet of the pancreatic exocrine system can cause pancreatitis. Cholelithiasis is the presence of stones in the gallbladder—chole- means "bile", lithia means "stone", and -sis means "process".
Size: A gallstone's size varies and may be as small as a sand grain or as large as a golf ball. The gallbladder may develop a single, often large, stone or many smaller ones, even several thousand.
Content:
Gallstones have different appearance, depending of their contents. On the basis of their contents, gallstones can be subdivided into the two following types:
Cholesterol stones
These are usually green, but are sometimes white or yellow in color and account for about 80 percent of gallstones. They are made primarily of cholesterol.
Pigment stones
These are small, dark stones made of bilirubin and calcium salts that are found in bile. They account for the other 20 percent of gallstones. Risk factors for pigment stones include cirrhosis, biliary tract infections, and hereditary blood cell disorders, such as sickle cell anemia. Stones of mixed origin also occur.
Causes:
Gallstones may be caused by a combination of factors, including inherited body chemistry, body weight, gallbladder motility (movement), and perhaps diet. Additionally, people with erythropoietic protoporphyria (EPP) are at increased risk to develop gallstones.
Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts.
How often and how well the gallbladder contracts; incomplete and infrequent emptying of the gallbladder may cause the bile to become overconcentrated and contribute to gallstone formation.
Presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstone.
Increased levels of the hormone oestrogen as a result of pregnancy, hormone therapy, or the use of combined (estrogen-containing) forms of hormonal contraception, may increase cholesterol levels in bile and also decrease gallbladder movement, resulting in gallstone formation.
However, low-fiber, high-cholesterol diets, and diets high in starchy foods have been suggested as contributing to gallstone formation.
Other nutritional factors that may increase risk of gallstones include rapid weight loss, constipation, eating fewer meals per day, eating less fish, and low intakes of the nutrients folate, magnesium, calcium, and vitamin C. On the other hand, wine and whole grain bread may decrease the risk of gallstones.
Symptoms
Usually remain asymptomatic initially. They start developing symptoms once the stones reach a certain size (>8mm).
Gall Stone “attack", in which a person will experience intense pain in the upper abdominal region that steadily increases for approximately thirty minutes to several hours. A victim may also encounter pain in the back, ordinarily between the shoulder blades, or pain under the right shoulder. In some cases, the pain develops in the lower region of the stomach, nearer to the pelvis.
Nausea and vomiting may occur.
Often, these attacks occur after a particularly fatty meal and almost always happen at night. Other symptoms include abdominal bloating, intolerance of fatty foods, belching, gas, and indigestion. If the above symptoms coincide with chills, low grade fever, yellowing of the skin or eyes, and/or clay-colored stool it means emergency hospitalization.
Some people who have gallstones are asymptomatic and do not feel any pain or discomfort. These gallstones are called "silent stones" and do not affect the gallbladder or other internal organs.
Diagnosis & Investigation:
Diagnosis can be made by palpating whether tenderness in right hypochondria.
Investigation: It can be made by Ultrasonography of abdomen.
Surgical Treatment :
Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis.
Homoeopathic Approach:
In homoeopathy we are having permanent cure for Gall stones and tendency to formation of gall stone & restoring his diseased condition to health. Homoeopathic treatment involves detail history taking by concentrating on general physical make up of person, diet, life style, sedentary habits, physical build up, food eating habits, appetite, stool, perspiration, body weight, present signs & symptoms, any treatment history or drug history, bowel habits, disordered from particular foods, sleep and temperament. Also his miasmatic background taken into consideration. In Homoeopathy disease diagnosis should be made with the help of modern investigation like USG, Liver Function Test and common disease symptoms should be separated from uncommon symptoms. In treating the case we should bear one thing mind after diagnosing through USG size of gall stone & thickness of wall of gall bladder should be concentrated as we are having limitation in gross pathological changes. For speedier relief in Gall Stone colic we may take help of medicines like Stigmata Madagus Q., Chionanthus Q., Dioscoria Q. in mother tincture form should be given as per symptoms indicate the medicine and in material doses. To avoid recurrence of gall stone Constitutional line of treatment must be given. In severe condition like acute cholecystitis with severe pain, fever, tenderness etc medicines like Belladonna, Dioscoria are of important value.
Repertorial Approach:
Synthesis Repertory
- Abdomen – Fullness, sensation of Liver – Gall Bladder.
- Abdomen – Gall Stone Colic
- Abdomen – Pain – Liver – colic, gall stones
- Abdomen – Pain – Right – extending to back.
- Stomach – Vomiting – bile
- Stool- bilious
Rubrics extracted from various repertory including Complete & Complete Millenium with common medicines:
D; Diseases; GALLSTONE, colic, pain (60) : Bell., Berb., Calc., Card-m., Chin., Chol.
D; Diseases; GALLSTONE, colic, pain; bending, forward amel. (4) : coloc., chin., card-m., mag-p.
D; Diseases; GALLSTONE, colic, pain; chill, with (1) : chel.
D; Diseases; GALLSTONE, colic, pain; dyspepsia, in chronic (1) : hydr-ac.
D; Diseases; GALLSTONE, colic, pain; fullness, sensation of (1) : myric.
D; Diseases; GALLSTONE, colic, pain; heaviness, stitches, burning, in one spot (1) : ph-ac.
D; Diseases; GALLSTONE, colic, pain; incarcerated, beaten up with yolk of egg, applied inwardly and outwardly (1) : nit-s-d.
D; Diseases; GALLSTONE, colic, pain; indigestion, after (1) : staph.
D; Diseases; GALLSTONE, colic, pain; jaundice, with (7) : Bell., Merc., Nux-v., card-m., podo., chel.
D; Diseases; GALLSTONE, colic, pain; jaundice, with; pain from region of stomach to region of gall bladder, with excessive nausea (1) : podo.
D; Diseases; GALLSTONE, colic, pain; jaundice, with; mercury or quinine, after (1) : Bell.
D; Diseases; GALLSTONE, colic, pain; pain, extending quickly downward across navel into intestines (1) : chel.
D; Diseases; GALLSTONE, colic, pain; periodic (1) : chin.
D; Diseases; GALLSTONE, colic, pain; radiating pains, with (2) : berb., chel.
D; Diseases; GALLSTONE, colic, pain; spreading over abdomen (1) : all-c.
D; Diseases; GALLSTONE, colic, pain; sticking pains, with (2) : card-m., chel.
D; Diseases; GALLSTONE, colic, pain; stools, with clay colored (1) : chel.
D; Diseases; GALLSTONE, colic, pain; touch, slight agg. (1) : chin.
D; Diseases; GALLSTONE, colic, pain; two weeks, every (1) : sep.
D; Diseases; GALLSTONE, colic, pain; violent pain between ileum and ribs (1) : lith-c.
D; Diseases; GALLSTONE, colic, pain; vomiting, with (1) : chel.
D; Diseases; GALLSTONE, colic, pain; warmth, amel. (1) : mag-p.
E; Emergency; GALLSTONES, gallbladder pain, colic, from (38) : Bell., Berb., Card-m., Chin., Coloc., Lyc.
L; Liver; GALLSTONE, colic pain from (60) : Bell., Berb., Calc., Card-m., Chin., Chol.
L; Liver; GALLSTONE, colic pain from; bending, forward amel. (4) : coloc., chin., card-m., mag-p.
L; Liver; GALLSTONE, colic pain from; chill, with (1) : chel.
L; Liver; GALLSTONE, colic pain from; dyspepsia, in chronic (1) : hydr-ac.
L; Liver; GALLSTONE, colic pain from; fullness, sensation of (1) : myric.
L; Liver; GALLSTONE, colic pain from; heaviness, stitches, burning, in one spot (1) : ph-ac.
L; Liver; GALLSTONE, colic pain from; incarcerated, beaten up with yolk of egg, applied inwardly and outwardly (1) : nit-s-d.
L; Liver; GALLSTONE, colic pain from; indigestion, after (1) : staph.
L; Liver; GALLSTONE, colic pain from; jaundice, with (7) : Bell., Merc., Nux-v., card-m., podo., chel.
L; Liver; GALLSTONE, colic pain from; jaundice, with; pain from region of stomach to region of gall bladder, with excessive nausea (1) : podo.
L; Liver; GALLSTONE, colic pain from; jaundice, with; mercury or quinine, after (1) : Bell.
L; Liver; GALLSTONE, colic pain from; pain, extending quickly downward across navel into intestines (1) : chel.
L; Liver; GALLSTONE, colic pain from; periodic (1) : chin.
L; Liver; GALLSTONE, colic pain from; radiating pains, with (2) : berb., chel.
L; Liver; GALLSTONE, colic pain from; spreading over abdomen (1) : all-c.
L; Liver; GALLSTONE, colic pain from; sticking pains, with (2) : card-m., chel.
L; Liver; GALLSTONE, colic pain from; stools, with clay colored (1) : chel.
L; Liver; GALLSTONE, colic pain from; touch, slight agg. (1) : chin.
L; Liver; GALLSTONE, colic pain from; two weeks, every (1) : sep.
L; Liver; GALLSTONE, colic pain from; violent pain between ileum and ribs (1) : lith-c.
L; Liver; GALLSTONE, colic pain from; vomiting, with (1) : chel.
L; Liver; GALLSTONE, colic pain from; warmth, amel. (1) : mag-p.
S; Skin; YELLOW skin,; gallstones, with (1) : podo.
Homoeopathic Materia Medica:
Dioscoria (2): It is useful medicine for Gall Stone & Gall stone Colic. There are wandering type of pain which suddenly shifts to different parts as back, chest, arms, fingers and toes. There is constant distress in umbilical and hypogastric region with severe cutting pain every few minutes in stomach and small intestines. There is rumbling in bowels and passing large quantity of flatulence. All symptoms are worse by doubling up (Opposite of Colosynth).
> STRETCHING OUT, BENDING BACK, Standing erect.
Lycopodium (3) : It is useful medicine for Gall stone, Gall bladder, Liver affection. Lycopodium is right sided remedy symptoms go from right to left side. There is pain in right hypchondrium extending to back (Chelidonium) worse by eating to satiety. Abdomen is full, bloated, distended in epigastrium after meal. Flatulence, fermentation, rumbling, rattling relieved by discharge of flatus and worse after eating. Colicky pains in abdomen. It is useful for Incarcerated flatus with pressure up and down with frequent urging to urinate. Patient cannot bear weight or pressure of clothes around waist it must be loosen. Constipation when traveling, away from home. Lycopodium desires sweets and hot drinks. Symptoms are worse from 4-8 pm, after eating, suffer from anticipation.
Chelidonium: It relieves Gall-stones colic in a few minutes when there are shooting, stabbing pains extending to the back and marked jaundice. It is indicated medicine for bilious complications during gestation. It is useful medicine for Jaundice due to hepatic and gall bladder obstruction. Abdomen is distended, fermentation and sluggish bowel. There is constriction across abdomen Sensation as by a string. It is useful for Gall stones, enlarged liver. There is constant pain under inferior angle of right scapula. There is yellow complexion worse on nose and cheek. Constipation with hard, round balls like sheep’s dung, alternation of diarrhoea and constipation.
Cardus Marians (3): It is a very important medicine for Gallstone disease with enlarged liver. There is Ailments from abuse of alcoholic beverages, especially beer. There is pain in region of liver extending to left shoulder, when lying on left side. There is pain under the right scapula near edge of the spine. Left lobe of Liver is very sensitive. There is fullness and soreness of Liver region with moist skin. Swelling of gall bladder with painful tenderness, hyperemia of liver, with jaundice. It is useful for Cirrhosis of liver with dropsical condition of abdomen depending on liver disease. Constipation with hard and insufficient, clay-colored, difficult, knottly stool alternates with diarrhea. It is useful for Bilious vomiting which is green, acid fluid. It acts better in tincture should be given 10 drops of tincture three times a day.
China (3): It is useful medicine for Gall Bladder affection. It is useful for Gall Stone in which bloated abdomen, flatulent colic in which abdomen feels packed, full worse after eating little not better by eructation. Patient feels better by bending double. There is pain in right hypochondrium. There is internal coldness of stomach and abdomen. It is indicated for Jaundice, Gastro-duodenal catarrh. There is vomiting of undigested foods. Diarrhoea in china is generally painless, debilitating, and watery with much flatus passes undigested food.
< After eating, bending over, at night.
> bending double, hard pressure.
Natrum Sulph (3): It is useful medicine for Liver and Gall Bladder problems like Gall stones. There is sharp, stitching pain in region of liver worse by touch, jar, lying on left side, tight clothes and better by lying right side with legs curdled up (Mag-m). There is indigestion and flatulence from farinaceous food worse before breakfast. Indicated for Diabetes mellitus. There is Headache with affections of the liver, gall Bladder, indigestion with bitter taste, vomiting of bile. There is Diarrhoea with yellow, bilious stool worse in morning after rising. Tongue is greenish – yellow discolored and yellow complexion. Urine is loaded with bile, brick-dust sediment. .
Veratrum Album(3) : It is useful medicine for Gall bladder affection. There is pain in abdomen preceding stool, cramps, knotting abdomen and legs. There is sinking and empty feeling in abdomen. Abdomen is swollen, terrible colic, sensitive to pressure. It is useful for copious vomiting and nausea worse by drinking and least motion. There is Great weakness after vomiting. Constipation from inactivity of rectum, with heat and headache. Stools are large, with much straining until exhausted, with cold sweat. Diarrhoea in Veratrum is very painful, watery, copious, and forcibly evacuated, followed by great prostration.
Berberis Vulgaris (3): It is important medicine for Gall Bladder Stone. There are stitches in region of gall-bladder worse by pressure, extending to stomach. It is useful for catarrh of the gall-bladder with constipation and yellow complexion. There are rapid change of symptoms - pains change in regard to place and character - thirst alternates with thirstlessness, hunger and loss of appetite, etc. It has also marked action on the liver, promoting the flow of bile. There is Diarrhoea which is painless, clay-colored, burning, and smarting in anus and perineum.
< by motion, standing.
Mag Mur (2): It is useful for Gall Bladder and liver affection. There is pressing pain in region of liver, Gall stone colic worse by lying on right side, slightest touch better by pressure (Chin, Mag-p). There is dragging when lying on left side extending to backwards (Chel, Lyc). It is useful for enlarged Liver with bloating of abdomen; yellow tongue. It is useful for INDIGESTION worse from MILK. Indicated medicine for Hepatitis, Gall Bladder stone & Liver affection. Constipation with sheep dung type of stools. Diarrhoea is worse from MILK.
< Immediately after eating, lying on right side.
> From pressure, motion
Belladonna (3): It is a great remedy during an attack of Gall-stones colic, relieving the pain instantaneously. There is bursting, pressing, throbbing pain in abdomen. There is pain in abdomen as if clutched by a hand. Abdomen is distended, hot, tender, swollen. There is cutting pain across abdomen, stitches in left side of abdomen when coughing, sneezing, touching it. Abdomen is very sensitive to touch. Nausea and vomiting with great thirst for cold water. Belladonna stands for violence of attack and suddenness of onset.
< by touch, jar, lying down.
> by semi-erect position.
Chionanthus (2): It is a prominent Liver remedy & useful for dissolving Gallstones. It is indicated for hepatic derangement, enlarged spleen, Jaundice & Diabetes Mellitus. There is aching in umbilical region, griping. Patient feels as if a string were tied in a "slip-knot" around intestines which was suddenly drawn tight and then gradually loosened. Region of Liver is sore, tender, enlarged liver with jaundice and constipation. Stools are clay-colored, soft, yellow and pasty. Tongue heavily coated. Urine is of high specific gravity, bile and sugar in urine. Skin is yellow, marked moisture of skin.
Ipecac (2): Indicated medicine for Gallstone colic with clean tongue. There is cutting, clutching type of pain worse around navel. There is constant nausea and vomiting with pale, twitching of face. Patient vomits food, bile, blood, mucus. Stomach feels relaxed, as if hanging down.
< periodically; from veal, lying down.
Terebinthinum (1): Terebinthinum is useful medicine for Gall stone Colic. There is enormous distention of abdomen. There is pain in abdomen before flatus with and relief after stool. It is useful for Diarrhoea with watery, greenish, fetid, bloody stool.
Calcarea Carb: It is useful medicine for Gall stones colic with great chilliness. There is profuse sweat, abdominal spasms, bend double, clench hands, write with agony. Dr. Farrington says “It has often stopped pain as by magic and has also cured permanently”.
Podophyllum (2): It is useful medicine for Gall stones with jaundice. There is pain from stomach towards gall bladder. With excessive nausea, alternate constipation and diarrhea. Also useful in Chronic hepatitis with constipation and jaundice. Patient constantly rubs the liver region with hands.
Use of Homoeopathic Medicines in Gall Stone Colic in mother Tincture form:
Cardus Marians Q. : When liver is prominently affected with torpidity, constipation etc. To check formation of stone Cardus M Q. 5 drops in an ounce of cool water twice daily.
Chionanthus Q.: When symptoms are associated with pain under right shoulder. It gives instant relief and insures radical cure in gall stone colic. Give Chinanthus Q. 10 drops in an ounce of water every hour and oftener during paroxysms of pain. To check the formation of gall stones and recurrence of pain give chionanthus Q. 5 drops thrice daily in an ounce of cool water.
Dioscoria Q. : When pain ameliorated by bending backward. Give Dioscoria Q. 5 drops every 10 to 15 minutes in biliary colic.
Cholestrinum 1 x : It is specific remedy to be used independently.
Stigmata madagus Q.: It relieves at once the violent pain if given during paroxysm. DR Hausen says “It is very beneficial medicine for intolerable pain during passing of gall-stones if given in Q. 20 drops every 10-15 minutes. “
Cactus Q.: Gall stones or renal colic with constriction and cardiac affection.
Biochemic Medicines for Gall Stones:
Repertory of Biochemic Medicines
- Abdomen and stool – Gall-Stones to prevent reformation of : Calc Phos
- Spasm from: Magn Phos
Biochemic Materia Medica:
Calcarea Phos: To prevent the re-formation of new stones.
Magnesia phos: Spasms from gall-stones.
Natrum Sulph: Cannot bear tight clothing around waist.
References:
Surgery by Love & Bailey
Comparative Materia Medica by E.A. Farrington
The Twelve Tissue Remedies of Schussler by Boericke & Dewey
Homoeopathic Materia Medica & Repertory by Dr. Willium Boericke
Homoeopathic Repertory by Dr. J.T. Kent
Synthesis Repertory Edition 8.1 edited by Dr. Fredrich Schroyens
A Dictionary of Practical Materia Medica by Dr. J.H. Clark
Clinical Repertory by Dr. Clark
Synoptic Key by Dr. Boger
Homoeopathic Therapeutics by Samuel Lilinthal
Tylers book on Homoeopathic Therapeutics
Complete 2005 Repertory
Murphy Repertory
BY
DR. PAWAN S. CHANDAK
Parbhani, Maharashtra
pavanchandak498@gmail.com
Gall Stone – General Medical Consideration:
In medicine, gallstones (choleliths) are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components.
Gallstones can occur anywhere within the biliary tree, including the gallbladder and the common bile duct. Obstruction of the common bile duct is choledocholithiasis; obstruction of the biliary tree can cause jaundice; obstruction of the outlet of the pancreatic exocrine system can cause pancreatitis. Cholelithiasis is the presence of stones in the gallbladder—chole- means "bile", lithia means "stone", and -sis means "process".
Size: A gallstone's size varies and may be as small as a sand grain or as large as a golf ball. The gallbladder may develop a single, often large, stone or many smaller ones, even several thousand.
Content:
Gallstones have different appearance, depending of their contents. On the basis of their contents, gallstones can be subdivided into the two following types:
Cholesterol stones
These are usually green, but are sometimes white or yellow in color and account for about 80 percent of gallstones. They are made primarily of cholesterol.
Pigment stones
These are small, dark stones made of bilirubin and calcium salts that are found in bile. They account for the other 20 percent of gallstones. Risk factors for pigment stones include cirrhosis, biliary tract infections, and hereditary blood cell disorders, such as sickle cell anemia. Stones of mixed origin also occur.
Causes:
Gallstones may be caused by a combination of factors, including inherited body chemistry, body weight, gallbladder motility (movement), and perhaps diet. Additionally, people with erythropoietic protoporphyria (EPP) are at increased risk to develop gallstones.
Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts.
How often and how well the gallbladder contracts; incomplete and infrequent emptying of the gallbladder may cause the bile to become overconcentrated and contribute to gallstone formation.
Presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstone.
Increased levels of the hormone oestrogen as a result of pregnancy, hormone therapy, or the use of combined (estrogen-containing) forms of hormonal contraception, may increase cholesterol levels in bile and also decrease gallbladder movement, resulting in gallstone formation.
However, low-fiber, high-cholesterol diets, and diets high in starchy foods have been suggested as contributing to gallstone formation.
Other nutritional factors that may increase risk of gallstones include rapid weight loss, constipation, eating fewer meals per day, eating less fish, and low intakes of the nutrients folate, magnesium, calcium, and vitamin C. On the other hand, wine and whole grain bread may decrease the risk of gallstones.
Symptoms
Usually remain asymptomatic initially. They start developing symptoms once the stones reach a certain size (>8mm).
Gall Stone “attack", in which a person will experience intense pain in the upper abdominal region that steadily increases for approximately thirty minutes to several hours. A victim may also encounter pain in the back, ordinarily between the shoulder blades, or pain under the right shoulder. In some cases, the pain develops in the lower region of the stomach, nearer to the pelvis.
Nausea and vomiting may occur.
Often, these attacks occur after a particularly fatty meal and almost always happen at night. Other symptoms include abdominal bloating, intolerance of fatty foods, belching, gas, and indigestion. If the above symptoms coincide with chills, low grade fever, yellowing of the skin or eyes, and/or clay-colored stool it means emergency hospitalization.
Some people who have gallstones are asymptomatic and do not feel any pain or discomfort. These gallstones are called "silent stones" and do not affect the gallbladder or other internal organs.
Diagnosis & Investigation:
Diagnosis can be made by palpating whether tenderness in right hypochondria.
Investigation: It can be made by Ultrasonography of abdomen.
Surgical Treatment :
Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis.
Homoeopathic Approach:
In homoeopathy we are having permanent cure for Gall stones and tendency to formation of gall stone & restoring his diseased condition to health. Homoeopathic treatment involves detail history taking by concentrating on general physical make up of person, diet, life style, sedentary habits, physical build up, food eating habits, appetite, stool, perspiration, body weight, present signs & symptoms, any treatment history or drug history, bowel habits, disordered from particular foods, sleep and temperament. Also his miasmatic background taken into consideration. In Homoeopathy disease diagnosis should be made with the help of modern investigation like USG, Liver Function Test and common disease symptoms should be separated from uncommon symptoms. In treating the case we should bear one thing mind after diagnosing through USG size of gall stone & thickness of wall of gall bladder should be concentrated as we are having limitation in gross pathological changes. For speedier relief in Gall Stone colic we may take help of medicines like Stigmata Madagus Q., Chionanthus Q., Dioscoria Q. in mother tincture form should be given as per symptoms indicate the medicine and in material doses. To avoid recurrence of gall stone Constitutional line of treatment must be given. In severe condition like acute cholecystitis with severe pain, fever, tenderness etc medicines like Belladonna, Dioscoria are of important value.
Repertorial Approach:
Synthesis Repertory
- Abdomen – Fullness, sensation of Liver – Gall Bladder.
- Abdomen – Gall Stone Colic
- Abdomen – Pain – Liver – colic, gall stones
- Abdomen – Pain – Right – extending to back.
- Stomach – Vomiting – bile
- Stool- bilious
Rubrics extracted from various repertory including Complete & Complete Millenium with common medicines:
D; Diseases; GALLSTONE, colic, pain (60) : Bell., Berb., Calc., Card-m., Chin., Chol.
D; Diseases; GALLSTONE, colic, pain; bending, forward amel. (4) : coloc., chin., card-m., mag-p.
D; Diseases; GALLSTONE, colic, pain; chill, with (1) : chel.
D; Diseases; GALLSTONE, colic, pain; dyspepsia, in chronic (1) : hydr-ac.
D; Diseases; GALLSTONE, colic, pain; fullness, sensation of (1) : myric.
D; Diseases; GALLSTONE, colic, pain; heaviness, stitches, burning, in one spot (1) : ph-ac.
D; Diseases; GALLSTONE, colic, pain; incarcerated, beaten up with yolk of egg, applied inwardly and outwardly (1) : nit-s-d.
D; Diseases; GALLSTONE, colic, pain; indigestion, after (1) : staph.
D; Diseases; GALLSTONE, colic, pain; jaundice, with (7) : Bell., Merc., Nux-v., card-m., podo., chel.
D; Diseases; GALLSTONE, colic, pain; jaundice, with; pain from region of stomach to region of gall bladder, with excessive nausea (1) : podo.
D; Diseases; GALLSTONE, colic, pain; jaundice, with; mercury or quinine, after (1) : Bell.
D; Diseases; GALLSTONE, colic, pain; pain, extending quickly downward across navel into intestines (1) : chel.
D; Diseases; GALLSTONE, colic, pain; periodic (1) : chin.
D; Diseases; GALLSTONE, colic, pain; radiating pains, with (2) : berb., chel.
D; Diseases; GALLSTONE, colic, pain; spreading over abdomen (1) : all-c.
D; Diseases; GALLSTONE, colic, pain; sticking pains, with (2) : card-m., chel.
D; Diseases; GALLSTONE, colic, pain; stools, with clay colored (1) : chel.
D; Diseases; GALLSTONE, colic, pain; touch, slight agg. (1) : chin.
D; Diseases; GALLSTONE, colic, pain; two weeks, every (1) : sep.
D; Diseases; GALLSTONE, colic, pain; violent pain between ileum and ribs (1) : lith-c.
D; Diseases; GALLSTONE, colic, pain; vomiting, with (1) : chel.
D; Diseases; GALLSTONE, colic, pain; warmth, amel. (1) : mag-p.
E; Emergency; GALLSTONES, gallbladder pain, colic, from (38) : Bell., Berb., Card-m., Chin., Coloc., Lyc.
L; Liver; GALLSTONE, colic pain from (60) : Bell., Berb., Calc., Card-m., Chin., Chol.
L; Liver; GALLSTONE, colic pain from; bending, forward amel. (4) : coloc., chin., card-m., mag-p.
L; Liver; GALLSTONE, colic pain from; chill, with (1) : chel.
L; Liver; GALLSTONE, colic pain from; dyspepsia, in chronic (1) : hydr-ac.
L; Liver; GALLSTONE, colic pain from; fullness, sensation of (1) : myric.
L; Liver; GALLSTONE, colic pain from; heaviness, stitches, burning, in one spot (1) : ph-ac.
L; Liver; GALLSTONE, colic pain from; incarcerated, beaten up with yolk of egg, applied inwardly and outwardly (1) : nit-s-d.
L; Liver; GALLSTONE, colic pain from; indigestion, after (1) : staph.
L; Liver; GALLSTONE, colic pain from; jaundice, with (7) : Bell., Merc., Nux-v., card-m., podo., chel.
L; Liver; GALLSTONE, colic pain from; jaundice, with; pain from region of stomach to region of gall bladder, with excessive nausea (1) : podo.
L; Liver; GALLSTONE, colic pain from; jaundice, with; mercury or quinine, after (1) : Bell.
L; Liver; GALLSTONE, colic pain from; pain, extending quickly downward across navel into intestines (1) : chel.
L; Liver; GALLSTONE, colic pain from; periodic (1) : chin.
L; Liver; GALLSTONE, colic pain from; radiating pains, with (2) : berb., chel.
L; Liver; GALLSTONE, colic pain from; spreading over abdomen (1) : all-c.
L; Liver; GALLSTONE, colic pain from; sticking pains, with (2) : card-m., chel.
L; Liver; GALLSTONE, colic pain from; stools, with clay colored (1) : chel.
L; Liver; GALLSTONE, colic pain from; touch, slight agg. (1) : chin.
L; Liver; GALLSTONE, colic pain from; two weeks, every (1) : sep.
L; Liver; GALLSTONE, colic pain from; violent pain between ileum and ribs (1) : lith-c.
L; Liver; GALLSTONE, colic pain from; vomiting, with (1) : chel.
L; Liver; GALLSTONE, colic pain from; warmth, amel. (1) : mag-p.
S; Skin; YELLOW skin,; gallstones, with (1) : podo.
Homoeopathic Materia Medica:
Dioscoria (2): It is useful medicine for Gall Stone & Gall stone Colic. There are wandering type of pain which suddenly shifts to different parts as back, chest, arms, fingers and toes. There is constant distress in umbilical and hypogastric region with severe cutting pain every few minutes in stomach and small intestines. There is rumbling in bowels and passing large quantity of flatulence. All symptoms are worse by doubling up (Opposite of Colosynth).
> STRETCHING OUT, BENDING BACK, Standing erect.
Lycopodium (3) : It is useful medicine for Gall stone, Gall bladder, Liver affection. Lycopodium is right sided remedy symptoms go from right to left side. There is pain in right hypchondrium extending to back (Chelidonium) worse by eating to satiety. Abdomen is full, bloated, distended in epigastrium after meal. Flatulence, fermentation, rumbling, rattling relieved by discharge of flatus and worse after eating. Colicky pains in abdomen. It is useful for Incarcerated flatus with pressure up and down with frequent urging to urinate. Patient cannot bear weight or pressure of clothes around waist it must be loosen. Constipation when traveling, away from home. Lycopodium desires sweets and hot drinks. Symptoms are worse from 4-8 pm, after eating, suffer from anticipation.
Chelidonium: It relieves Gall-stones colic in a few minutes when there are shooting, stabbing pains extending to the back and marked jaundice. It is indicated medicine for bilious complications during gestation. It is useful medicine for Jaundice due to hepatic and gall bladder obstruction. Abdomen is distended, fermentation and sluggish bowel. There is constriction across abdomen Sensation as by a string. It is useful for Gall stones, enlarged liver. There is constant pain under inferior angle of right scapula. There is yellow complexion worse on nose and cheek. Constipation with hard, round balls like sheep’s dung, alternation of diarrhoea and constipation.
Cardus Marians (3): It is a very important medicine for Gallstone disease with enlarged liver. There is Ailments from abuse of alcoholic beverages, especially beer. There is pain in region of liver extending to left shoulder, when lying on left side. There is pain under the right scapula near edge of the spine. Left lobe of Liver is very sensitive. There is fullness and soreness of Liver region with moist skin. Swelling of gall bladder with painful tenderness, hyperemia of liver, with jaundice. It is useful for Cirrhosis of liver with dropsical condition of abdomen depending on liver disease. Constipation with hard and insufficient, clay-colored, difficult, knottly stool alternates with diarrhea. It is useful for Bilious vomiting which is green, acid fluid. It acts better in tincture should be given 10 drops of tincture three times a day.
China (3): It is useful medicine for Gall Bladder affection. It is useful for Gall Stone in which bloated abdomen, flatulent colic in which abdomen feels packed, full worse after eating little not better by eructation. Patient feels better by bending double. There is pain in right hypochondrium. There is internal coldness of stomach and abdomen. It is indicated for Jaundice, Gastro-duodenal catarrh. There is vomiting of undigested foods. Diarrhoea in china is generally painless, debilitating, and watery with much flatus passes undigested food.
< After eating, bending over, at night.
> bending double, hard pressure.
Natrum Sulph (3): It is useful medicine for Liver and Gall Bladder problems like Gall stones. There is sharp, stitching pain in region of liver worse by touch, jar, lying on left side, tight clothes and better by lying right side with legs curdled up (Mag-m). There is indigestion and flatulence from farinaceous food worse before breakfast. Indicated for Diabetes mellitus. There is Headache with affections of the liver, gall Bladder, indigestion with bitter taste, vomiting of bile. There is Diarrhoea with yellow, bilious stool worse in morning after rising. Tongue is greenish – yellow discolored and yellow complexion. Urine is loaded with bile, brick-dust sediment. .
Veratrum Album(3) : It is useful medicine for Gall bladder affection. There is pain in abdomen preceding stool, cramps, knotting abdomen and legs. There is sinking and empty feeling in abdomen. Abdomen is swollen, terrible colic, sensitive to pressure. It is useful for copious vomiting and nausea worse by drinking and least motion. There is Great weakness after vomiting. Constipation from inactivity of rectum, with heat and headache. Stools are large, with much straining until exhausted, with cold sweat. Diarrhoea in Veratrum is very painful, watery, copious, and forcibly evacuated, followed by great prostration.
Berberis Vulgaris (3): It is important medicine for Gall Bladder Stone. There are stitches in region of gall-bladder worse by pressure, extending to stomach. It is useful for catarrh of the gall-bladder with constipation and yellow complexion. There are rapid change of symptoms - pains change in regard to place and character - thirst alternates with thirstlessness, hunger and loss of appetite, etc. It has also marked action on the liver, promoting the flow of bile. There is Diarrhoea which is painless, clay-colored, burning, and smarting in anus and perineum.
< by motion, standing.
Mag Mur (2): It is useful for Gall Bladder and liver affection. There is pressing pain in region of liver, Gall stone colic worse by lying on right side, slightest touch better by pressure (Chin, Mag-p). There is dragging when lying on left side extending to backwards (Chel, Lyc). It is useful for enlarged Liver with bloating of abdomen; yellow tongue. It is useful for INDIGESTION worse from MILK. Indicated medicine for Hepatitis, Gall Bladder stone & Liver affection. Constipation with sheep dung type of stools. Diarrhoea is worse from MILK.
< Immediately after eating, lying on right side.
> From pressure, motion
Belladonna (3): It is a great remedy during an attack of Gall-stones colic, relieving the pain instantaneously. There is bursting, pressing, throbbing pain in abdomen. There is pain in abdomen as if clutched by a hand. Abdomen is distended, hot, tender, swollen. There is cutting pain across abdomen, stitches in left side of abdomen when coughing, sneezing, touching it. Abdomen is very sensitive to touch. Nausea and vomiting with great thirst for cold water. Belladonna stands for violence of attack and suddenness of onset.
< by touch, jar, lying down.
> by semi-erect position.
Chionanthus (2): It is a prominent Liver remedy & useful for dissolving Gallstones. It is indicated for hepatic derangement, enlarged spleen, Jaundice & Diabetes Mellitus. There is aching in umbilical region, griping. Patient feels as if a string were tied in a "slip-knot" around intestines which was suddenly drawn tight and then gradually loosened. Region of Liver is sore, tender, enlarged liver with jaundice and constipation. Stools are clay-colored, soft, yellow and pasty. Tongue heavily coated. Urine is of high specific gravity, bile and sugar in urine. Skin is yellow, marked moisture of skin.
Ipecac (2): Indicated medicine for Gallstone colic with clean tongue. There is cutting, clutching type of pain worse around navel. There is constant nausea and vomiting with pale, twitching of face. Patient vomits food, bile, blood, mucus. Stomach feels relaxed, as if hanging down.
< periodically; from veal, lying down.
Terebinthinum (1): Terebinthinum is useful medicine for Gall stone Colic. There is enormous distention of abdomen. There is pain in abdomen before flatus with and relief after stool. It is useful for Diarrhoea with watery, greenish, fetid, bloody stool.
Calcarea Carb: It is useful medicine for Gall stones colic with great chilliness. There is profuse sweat, abdominal spasms, bend double, clench hands, write with agony. Dr. Farrington says “It has often stopped pain as by magic and has also cured permanently”.
Podophyllum (2): It is useful medicine for Gall stones with jaundice. There is pain from stomach towards gall bladder. With excessive nausea, alternate constipation and diarrhea. Also useful in Chronic hepatitis with constipation and jaundice. Patient constantly rubs the liver region with hands.
Use of Homoeopathic Medicines in Gall Stone Colic in mother Tincture form:
Cardus Marians Q. : When liver is prominently affected with torpidity, constipation etc. To check formation of stone Cardus M Q. 5 drops in an ounce of cool water twice daily.
Chionanthus Q.: When symptoms are associated with pain under right shoulder. It gives instant relief and insures radical cure in gall stone colic. Give Chinanthus Q. 10 drops in an ounce of water every hour and oftener during paroxysms of pain. To check the formation of gall stones and recurrence of pain give chionanthus Q. 5 drops thrice daily in an ounce of cool water.
Dioscoria Q. : When pain ameliorated by bending backward. Give Dioscoria Q. 5 drops every 10 to 15 minutes in biliary colic.
Cholestrinum 1 x : It is specific remedy to be used independently.
Stigmata madagus Q.: It relieves at once the violent pain if given during paroxysm. DR Hausen says “It is very beneficial medicine for intolerable pain during passing of gall-stones if given in Q. 20 drops every 10-15 minutes. “
Cactus Q.: Gall stones or renal colic with constriction and cardiac affection.
Biochemic Medicines for Gall Stones:
Repertory of Biochemic Medicines
- Abdomen and stool – Gall-Stones to prevent reformation of : Calc Phos
- Spasm from: Magn Phos
Biochemic Materia Medica:
Calcarea Phos: To prevent the re-formation of new stones.
Magnesia phos: Spasms from gall-stones.
Natrum Sulph: Cannot bear tight clothing around waist.
References:
Surgery by Love & Bailey
Comparative Materia Medica by E.A. Farrington
The Twelve Tissue Remedies of Schussler by Boericke & Dewey
Homoeopathic Materia Medica & Repertory by Dr. Willium Boericke
Homoeopathic Repertory by Dr. J.T. Kent
Synthesis Repertory Edition 8.1 edited by Dr. Fredrich Schroyens
A Dictionary of Practical Materia Medica by Dr. J.H. Clark
Clinical Repertory by Dr. Clark
Synoptic Key by Dr. Boger
Homoeopathic Therapeutics by Samuel Lilinthal
Tylers book on Homoeopathic Therapeutics
Complete 2005 Repertory
Murphy Repertory
Management:
Preparation
o You can't clean a liver with living parasites in it. You won't get many stones, and you will feel quite sick. Zap daily the week before and complete the parasite killing program before attempting a liver cleanse. If you are on the maintenance parasite program, you are always ready to do the cleanse.
o Completing the kidney cleanse before cleansing the liver is also highly recommended. You want your kidneys, bladder and urinary tract in top working condition so they can efficiently remove any undesirable substances incidentally absorbed from the intestine as the bile is being excreted.
Ingredients
o Epsom salts: 4 tablespoons
o Olive oil: half cup (light olive oil is easier to get down), and for best results, ozonate it for 20 minutes. Add 2 drops HCl.
o Fresh pink grapefruit: 1 large or 2 small, enough to squeeze 2/3 cup juice. Hot wash twice first and dry each time.
o Ornithine: 4 to 8, to be sure you can sleep. Don’t skip this or you may have the worst night of your life!
o Large plastic straw: to help drink potion.
o Pint jar with lid
o Black Walnut Tincture, any strength: 10 to 20 drops, to kill parasites coming from the liver.
Choose a day like Saturday for the cleanse, since you will be able to rest the next day. Take no medicines, vitamins or pills that you can do without; they could prevent success. Stop the parasite program and kidney herbs, too, the day before. Eat a no-fat breakfast and lunch such as cooked cereal, fruit, fruit juice, bread and preserves or honey (no butter or milk). This allows the bile to build up and develop pressure in the liver. Higher pressure pushes out more stones.
2:00 PM. Do not eat or drink after 2 o'clock. If you break this rule you could feel quite ill later. Get your Epsom salts ready. Mix 4 tbs. in 3 cups water and pour this into a jar. This makes four servings, ¾ cup each. Set the jar in the refrigerator to get ice cold (this is for convenience and taste only).
6:00 PM. Drink one serving (¾ cup) of the ice cold Epsom salts. If you did not prepare this ahead of time, mix 1 tbs. in ¾ cup water now. You may add 1/8 tsp. vitamin C powder to improve the taste. You may also drink a few mouthfuls of water afterwards or rinse your mouth. Get the olive oil (ozonated, if possible) and grapefruit out to warm up.
8:00 PM. Repeat by drinking another ¾ cup of Epsom salts.You haven't eaten since two o'clock, but you won't feel hungry. Get your bedtime chores done. The timing is critical for success.
9:45 PM. Pour ½ cup (measured) olive oil into the pint jar. Add 2 drops HCl to sterilize. Wash grapefruit twice in hot water and dry; squeeze by hand into the measuring cup. Remove pulp with fork. You should have at least ½ cup, more (up to ¾ cup) is best. You may use part lemonade. Add this to the olive oil. Also add Black Walnut Tincture. Close the jar tightly with the lid and shake hard until watery (only fresh grapefruit juice does this).
Now visit the bathroom one or more time, even if it makes you late for your ten o'clock drink. Don't be more than 15 minutes late. You will get fewer stones.
10:00 PM. Drink the potion you have mixed. Take 4 ornithine capsules with the first sips to make sure you will sleep through the night. Take 8 if you already suffer from insomnia. Drinking through a large plastic straw helps it go down easier. You may use oil and vinegar salad dressing, or straight honey to chase it down between sips. Have these ready in a tablespoon on the kitchen counter. Take it all to your bedside if you want, but drink it standing up. Get it down within 5 minutes (fifteen minutes for very elderly or weak persons).
Lie down immediately. You might fail to get stones out if you don't. The sooner you lie down the more stones you will get out. Be ready for bed ahead of time. Don't clean up the kitchen. As soon as the drink is down walk to your bed and lie down flat on your back with your head up high on the pillow. Try to think about what is happening in the liver. Try to keep perfectly still for at least 20 minutes. You may feel a train of stones traveling along the bile ducts like marbles. There is no pain because the bile duct valves are open (thank you Epsom salts!). Go to sleep, you may fail to get stones out if you don't.
Next morning. Upon awakening take your third dose of Epsom salts. If you have indigestion or nausea wait until it is gone before drinking the Epsom salts. You may go back to bed. Don't take this potion before 6:00 am.
2 Hours Later. Take your fourth (the last) dose of Epsom salts. You may go back to bed again.
After 2 More Hours you may eat. Start with fruit juice. Half an hour later eat fruit. One hour later you may eat regular food but keep it light. By supper you should feel recovered.
How well did you do? Expect diarrhea in the morning. Use a flashlight to look for gallstones in the toilet with the bowel movement. Look for the green kind since this is proof that they are genuine gallstones, not food residue. Only bile from the liver is pea green. The bowel movement sinks but gallstones float because of the cholesterol inside. Count them all roughly, whether tan or green. You will need to total 2000 stones before the liver is clean enough to rid you of allergies or bursitis or upper back pains permanently. The first cleanse may rid you of them for a few days, but as the stones from the rear travel forward, they give you the same symptoms again. You may repeat cleanses at two week intervals. Never cleanse when you are [acutely] ill.
Sometimes the bile ducts are full of cholesterol crystals that did not form into round stones. They appear as a “chaff” floating on top of the toilet bowl water. It may be tan colored, harboring millions of tiny white crystals. Cleansing this chaff is just as important as purging stones.
How safe is the liver cleanse? It is very safe. My opinion is based on over 500 cases, including many persons in their seventies and eighties. None went to the hospital; none even reported pain. However it can make you feel quite ill for one or two days afterwards, although in every one of these cases the maintenance parasite program had been neglected. This is why the instructions direct you to complete the parasite and kidney cleanse programs first.
o You can't clean a liver with living parasites in it. You won't get many stones, and you will feel quite sick. Zap daily the week before and complete the parasite killing program before attempting a liver cleanse. If you are on the maintenance parasite program, you are always ready to do the cleanse.
o Completing the kidney cleanse before cleansing the liver is also highly recommended. You want your kidneys, bladder and urinary tract in top working condition so they can efficiently remove any undesirable substances incidentally absorbed from the intestine as the bile is being excreted.
Ingredients
o Epsom salts: 4 tablespoons
o Olive oil: half cup (light olive oil is easier to get down), and for best results, ozonate it for 20 minutes. Add 2 drops HCl.
o Fresh pink grapefruit: 1 large or 2 small, enough to squeeze 2/3 cup juice. Hot wash twice first and dry each time.
o Ornithine: 4 to 8, to be sure you can sleep. Don’t skip this or you may have the worst night of your life!
o Large plastic straw: to help drink potion.
o Pint jar with lid
o Black Walnut Tincture, any strength: 10 to 20 drops, to kill parasites coming from the liver.
Choose a day like Saturday for the cleanse, since you will be able to rest the next day. Take no medicines, vitamins or pills that you can do without; they could prevent success. Stop the parasite program and kidney herbs, too, the day before. Eat a no-fat breakfast and lunch such as cooked cereal, fruit, fruit juice, bread and preserves or honey (no butter or milk). This allows the bile to build up and develop pressure in the liver. Higher pressure pushes out more stones.
2:00 PM. Do not eat or drink after 2 o'clock. If you break this rule you could feel quite ill later. Get your Epsom salts ready. Mix 4 tbs. in 3 cups water and pour this into a jar. This makes four servings, ¾ cup each. Set the jar in the refrigerator to get ice cold (this is for convenience and taste only).
6:00 PM. Drink one serving (¾ cup) of the ice cold Epsom salts. If you did not prepare this ahead of time, mix 1 tbs. in ¾ cup water now. You may add 1/8 tsp. vitamin C powder to improve the taste. You may also drink a few mouthfuls of water afterwards or rinse your mouth. Get the olive oil (ozonated, if possible) and grapefruit out to warm up.
8:00 PM. Repeat by drinking another ¾ cup of Epsom salts.You haven't eaten since two o'clock, but you won't feel hungry. Get your bedtime chores done. The timing is critical for success.
9:45 PM. Pour ½ cup (measured) olive oil into the pint jar. Add 2 drops HCl to sterilize. Wash grapefruit twice in hot water and dry; squeeze by hand into the measuring cup. Remove pulp with fork. You should have at least ½ cup, more (up to ¾ cup) is best. You may use part lemonade. Add this to the olive oil. Also add Black Walnut Tincture. Close the jar tightly with the lid and shake hard until watery (only fresh grapefruit juice does this).
Now visit the bathroom one or more time, even if it makes you late for your ten o'clock drink. Don't be more than 15 minutes late. You will get fewer stones.
10:00 PM. Drink the potion you have mixed. Take 4 ornithine capsules with the first sips to make sure you will sleep through the night. Take 8 if you already suffer from insomnia. Drinking through a large plastic straw helps it go down easier. You may use oil and vinegar salad dressing, or straight honey to chase it down between sips. Have these ready in a tablespoon on the kitchen counter. Take it all to your bedside if you want, but drink it standing up. Get it down within 5 minutes (fifteen minutes for very elderly or weak persons).
Lie down immediately. You might fail to get stones out if you don't. The sooner you lie down the more stones you will get out. Be ready for bed ahead of time. Don't clean up the kitchen. As soon as the drink is down walk to your bed and lie down flat on your back with your head up high on the pillow. Try to think about what is happening in the liver. Try to keep perfectly still for at least 20 minutes. You may feel a train of stones traveling along the bile ducts like marbles. There is no pain because the bile duct valves are open (thank you Epsom salts!). Go to sleep, you may fail to get stones out if you don't.
Next morning. Upon awakening take your third dose of Epsom salts. If you have indigestion or nausea wait until it is gone before drinking the Epsom salts. You may go back to bed. Don't take this potion before 6:00 am.
2 Hours Later. Take your fourth (the last) dose of Epsom salts. You may go back to bed again.
After 2 More Hours you may eat. Start with fruit juice. Half an hour later eat fruit. One hour later you may eat regular food but keep it light. By supper you should feel recovered.
How well did you do? Expect diarrhea in the morning. Use a flashlight to look for gallstones in the toilet with the bowel movement. Look for the green kind since this is proof that they are genuine gallstones, not food residue. Only bile from the liver is pea green. The bowel movement sinks but gallstones float because of the cholesterol inside. Count them all roughly, whether tan or green. You will need to total 2000 stones before the liver is clean enough to rid you of allergies or bursitis or upper back pains permanently. The first cleanse may rid you of them for a few days, but as the stones from the rear travel forward, they give you the same symptoms again. You may repeat cleanses at two week intervals. Never cleanse when you are [acutely] ill.
Sometimes the bile ducts are full of cholesterol crystals that did not form into round stones. They appear as a “chaff” floating on top of the toilet bowl water. It may be tan colored, harboring millions of tiny white crystals. Cleansing this chaff is just as important as purging stones.
How safe is the liver cleanse? It is very safe. My opinion is based on over 500 cases, including many persons in their seventies and eighties. None went to the hospital; none even reported pain. However it can make you feel quite ill for one or two days afterwards, although in every one of these cases the maintenance parasite program had been neglected. This is why the instructions direct you to complete the parasite and kidney cleanse programs first.
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