Indian Journal of Research in Homoeopathy

Volume 16 Issue 1 Article 6

29-3-2022

Individualized homeopathy in a case of liver abscess: A case

report
Jyoti Chhikara
Homoeopathic Consultants, New Delhi, India, drjyotichhikara93@gmail.com
Rahul Singh
Homoeopathic Consultants, New Delhi, India, drrahulsingh.9889@gmail.com

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How to cite this article

Chhikara J, Singh R. Individualized homeopathy in a case of liver abscess: A case report. Indian J Res
Homoeopathy 2022;16(1). doi: 10.53945/2320-7094.1059

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Individualized homeopathy in a case of liver abscess: A case report

Abstract
Introduction
Introduction: Liver abscesses (LAs) are purulent collections in the liver parenchyma that result from
bacterial, fungal, or parasitic infection which can spread to the liver by extension of an adjacent infection,
or as a result of trauma. Homoeopathic approach of treating the disease based on symptom totality is a
relevant alternative to often unsatisfactory conventional medicine in cases of LA.

Case Summary
Summary: A 35-yearold male who presented with LA was treated with homoeopathic medicine
based on the totality of symptoms and significant improvement was seen with resolution of abscess in
the liver along with relief in other presenting symptoms. This enhances our belief in the potential of
individualized homeopathy in treating infectious conditions.

Acknowledgments and Source of Funding

.

This case report is available in Indian Journal of Research in Homoeopathy: https://www.ijrh.org/journal/vol16/iss1/6

 Case Report

Individualized homeopathy in a case of liver

abscess: A case report
Jyoti Chhikara, Rahul Singh
Homoeopathic Consultants, New Delhi, India

Abstract
Introduction: Liver abscesses (LAs) are purulent collections in the liver parenchyma that result from bacterial, fungal, or parasitic infection
which can spread to the liver by extension of an adjacent infection, or as a result of trauma. Homoeopathic approach of treating the disease
based on symptom totality is a relevant alternative to often unsatisfactory conventional medicine in cases of LA. Case Summary: A 35-year-
old male who presented with LA was treated with homoeopathic medicine based on the totality of symptoms and significant improvement
was seen with resolution of abscess in the liver along with relief in other presenting symptoms. This enhances our belief in the potential of
individualized homeopathy in treating infectious conditions.

Keywords: Bryonia alba, Homoeopathy, Individualization, Liver abscess

Introduction 80% of patients. The incidence of LA is low but the mortality risk
remains high in untreated patients.[4] The initial test of choice is
Liver abscess (LA) is a pus-filled mass in the liver that
abdominal ultrasonography, which shows hyper or hypo-echoic
develops from injury to the liver or an intra-abdominal infection
lesions with occasional debris or septation.
disseminated from the portal circulation. It occurs most commonly
in the age group of 20–45 years and males are more frequently Homoeopathic remedies can offer gentle and safe treatment
affected than females.[1] LA can arrive either from an ischemic for patients suffering from LA. Homeopathy is an alternative
episode or by bacteria entering through the portal vein.[2,3] Septic system of medicine where the selection of remedy is based upon
emboli cause several micro-abscesses which combine to form detailed medical history of the patient, family and causative
one large abscess. Hematogenous spread from endocarditis or factors, underlying predisposition factor, and susceptibility.
pyelonephritis can happen. It can be either pyogenic or amoebic. This case highlights the importance of individualization and
Most amoebic infections are caused by Entamoeba histolytica. law of single, simple homoeopathic medicine in the treatment
The pyogenic abscesses have polymicrobial origin, such as of LA.
Escherichia coli, Klebsiella, Streptococcus, Staphylococcus, and
anaerobes. About 50% of solitary LAs occur in the right lobe of Case Report
the liver (a more significant part with more blood supply), less
commonly in the left liver lobe or caudate lobe. LA may present Patient information
as an acute process or as a chronic disease, based on duration of A 35-year-old male presented with acute pain in the right
illness and severity. Most patients present with an acute illness hypochondriac region with aggravation of pain on any kind
and duration of symptoms <2 weeks with abdominal pain usually
moderate and localized to the right upper quadrant, fever, and *Address for correspondence: Jyoti Chhikara,
anorexia as presenting features. Diffuse abdominal pain, pleuritic Department of Pulmonary Medicine, Critical Care and Sleep
Disorders, All India Institute of Medical Sciences, New Delhi, India.
chest pain, and radiation of right upper quadrant pain to the right E-mail: drjyotichhikara93@gmail.com
shoulder are not uncommon. Fever is of moderate degree in most
cases, while high fever with chills is suggestive of secondary Received: 19 September 2020; Accepted: 18 February 2022
bacterial infection. Tender hepatomegaly is detected in up to
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DOI: How to cite this article: Chhikara J, Singh R. Individualized homeopathy
10.53945/2320-7094.1059 in a case of liver abscess: A case report. Indian J Res Homoeopathy
2022;16(1):55-60.

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 Chhikara and Singh: Individualised homeopathy in a case of liver abscess

of movement, even breathing, with a history of fever 3 days Totality of symptoms

ago. These complaints were there in the past 2 days but had The patient was timid, and anxious about how he developed the
worsened on the day of reporting. disease, worried about his work (as he would have to take leave),
Patient had not received any treatment before reporting. He also answered briefly (most answers had to confirmed from attendant);
had an episode of watery stools with slight nausea. There was did not want to talk, wanted to be quiet, and take rest, desired
a constant urge to urinate frequently, with pain in right lower cold food and drinks, had unquenchable thirst for cold water,
abdomen with fever and chills one week ago. Patient wanted to sensation of fullness of bladder, frequent desire to urinate, loose
stay still, and kept his hand over the liver region and mentioned stools since morning, pain in the right side of the abdomen (right
that his pain ameliorated on application of slight pressure. hypochondrium), desire for complete rest, pain better by pressure.

There was no history of recent consumption of food from Analysis of the case
outside. Appetite was poor since the pain developed, but he After analyzing the symptoms of the case, the characteristic
was constantly thirsty and desired cold water. mentals, physical generals and particular symptoms were
considered for framing the totality. Timidity, desire to be quiet,
Personal history and worried about business, desired cold food and drinks, had
Family history of hepatic disease or any other comorbidity was unquenchable thirst for cold water were the important general
negative. He had a habit of taking highly spiced and fried food, symptoms while frequent desire to urinate, loose stools since
and drinking less quantity of liquids. There was no history of morning, pain in the right side of abdomen better by pressure
consumption of alcoholic drinks or tobacco in any form. were the particulars included in totality. Repertorisation was done
using RADAR (Synthesis 8.1),[5] and the symptoms considered for
Clinical and laboratory findings
repertorisation are shown in Figure 2. Bryonia alba was the highest
On abdominal examination, tenderness was observed in
scoring medicine and covered maximum rubrics in higher grade.
right hypochondrium which ameliorated on applying gentle
pressure over the region. There was continuous moderate pain Intervention
of stitching character. No sign of guarding could be elicited. Homoeopathic medicines Bryonia alba, Sulphur, Arsenic album,
and Belladona were the top four medicines in the repertorisation
Investigations such as complete blood count, liver function
sheet. Bryonia alba covered the totality of the patient in the highest
tests, inflammatory markers, coagulation profile were advised
grade. The characteristic burning of Sulphur was not present as
but not done as the patient had financial constraints, due to
a chief complaint and desire to be quiet and rest, was also not
which only ultrasonography could be performed.
covered by it, hence not selected as similimum for the case. The
Ultrasonography of abdomen revealed hepatomegaly with characteristic restlessness and amelioration by warmth of Arsenic
liver span of 18–19 cm, with a hypo-echoic lesion of 88 × album was not present in this case, also the characteristic modality
78 × 68 mm with volume of 230 cc in right lobe. Spleen was of amelioration of pain by pressure was not covered under
enlarged to a span of 15.8 cm. There was hepatomegaly with Arsenic after repertorisation. Belladona is an excellent remedy
evolving LA and splenomegaly as seen in Figure 1. for pyogenic conditions of skin and glands, but the characteristic
modalities of Belladona, that is, aggravation from touch, lying
Provisional diagnosis
down were contradictory in this case, as the patient reported pain
Amoebic LA.
better by pressure and had desire to rest. Bryonia was selected as
the similimum of the case on the basis of totality, individualization,
and after consideration of Materia Medica and Repertory.
Prescription
Three doses of Bryonia alba 200C were prescribed on 13 July
2020, to be taken at 6 h intervals followed by placebo for 5 days.
On subsequent follow-ups, repetition of medicine was done upon
assessment of symptoms and investigations. The patient was taking
only homoeopathic medicines during the course of treatment.
Patient was advised to avoid all kinds of oily and fried food,
take plenty of water and avoid overeating. He was also asked
to take adequate rest and refrain from any kind of strenuous
activity. During the course of treatment, patient did not have
to take antibiotics or any other conventional treatment.
Follow-up
During the follow-ups, the patient’s status was assessed and
Figure 1: Ultrasonography- whole abdomen (13 June, 2020) showing a subsequent ultrasonography was done at 15-day intervals for
hypo-echoic lesion in the right lobe of liver 1 month. Follow-ups details are summarized in Table 1.

56 Indian Journal of Research in Homoeopathy ¦ Volume 16 ¦ Issue 1 ¦ Jan-Mar 2022

 Chhikara and Singh: Individualised homeopathy in a case of liver abscess

Figure 2: Repertorisation: RADAR (Synthesis 8.1)

Table 1: Timeline of the follow‑up

S. No Date Symptoms/findings Prescription
1. 13 June, 2020 USG Abdomen [Figure 1] ‑Hepatomegaly with liver span of 18–19 cm with a Bryonia alba 200 C/3 doses/6
hypo‑echoic lesion 88×78×68 mms with volume of 230 cc in right lobe. Spleen hourly
enlarged to a span of 15.8 cm. “Hepatomegaly with evolving liver abscess in right lobe Followed by Placebo 200 C/
with Splenomegaly” TDS/5 days
2. 18 June, 2020 Patient reported that pain had subsided to about 80% by the next day after reporting. Placebo 200 C/TDS/10 days
The pain was better but there was mild irritation in the right hypochondriac
region<exhalation, sneezing, coughing. There was no episode of loose stools, fever
after the first prescription
3. 27 June, 2020 Appetite much improved and thirst for cold water, after which he felt better. Frequency Bryonia alba 200 C/1 dose/OM
of urination decreased Followed by Placebo 200 C/
USG – Abdomen report revealed mild hepatomegaly with a hypo‑echoic lesion TDS/15 days
69×68×66 mms with volume of 150 cc in right lobe (resolving). Spleen enlarged to a
span of 14.8 cm. A small hypo‑echoic lesion measuring 34×21 mms posterior to this
lesion has appeared
4. 11 August, 2020 Patient was feeling better with no pain. Appetite was much improved. Desire for spicy, Placebo 200 C/TDS/15 days
fried food. Stools were satisfactory with no alterations. Patient has resumed going to
work
USG – Abdomen revealed a liver of normal size with resolving abscess and cystic
lesion of about 50 cc volume in right lobe. No pus is seen to be present. Another
tiny lesion measuring 34×21 mms which appeared in right lobe in previous scan has
reduced in size, now measuring 10×11 mms
5. 11 September, 2020 No complain of pain even on exertion; appetite restored to normal and no mental Placebo 200 C/TDS/15 days
anxiety
Patient had reported that the improvement of his complaints with homoeopathic
treatment strengthened his belief in homoeopathy

The presented case of LA showed marked improvement with positively to the homoeopathic treatment and was relieved of
single homeopathic medicine Bryonia alba. There was significant his pain, with an effective resolution and reduction of pus, as
clinical as well as radiographic progress, in over a period of evident from the ultrasound reports. On subsequent follow-up,
1 month of treatment, inferred on the basis of improvement of liver biopsy and FNAC to rule out whether pyogenic or amoebic
generals and particular symptoms of the case as well as resolution LA was advised but was not performed as patient showed
of abscess and regression of liver to its pre-infection size as symptomatic relief and had already discussed his financial
evident via series of ultrasonography [Figures 3 and 4]. limitations. It was treated as probable case of amoebic LA based
on sudden history of onset of abdominal pain, fever with chills,
Discussion and involvement of the right lobe of the liver mainly.[6] The
This case highlights the usefulness of homoeopathic medicines case was assessed for the likelihood of causality between the
in the management of LA. In this case, after careful history homoeopathic intervention and outcome as per Modified Naranjo
recording, repertorisation, and consultation with Materia Medica, criteria for Homoeopathy.[7] Under MoNarCh[7] domains 3, 7, 6,
Bryonia alba was prescribed. The patient had not undergone and 10 were not established in this report but other domains were
any treatment before for this complaint. The patient responded largely established. The total score of outcome was 8 [Table 2]

Indian Journal of Research in Homoeopathy ¦ Volume 16 ¦ Issue 1 ¦ Jan-Mar 2022 57

 Chhikara and Singh: Individualised homeopathy in a case of liver abscess

Table 2: Monarch inventory (improved version of the modified Naranjo criteria for Homoeopathy)[7]
Domains Yes No Not sure Score for successfully Justification
or N/A treated cases
Was there an improvement in the main symptom or +2 –1 0 2 Right hypochondrium pain (due to underlying
condition for which the homoeopathic medicine was LA) was the chief complain which disappeared
prescribed? after treatment
Did the clinical improvement occur within a plausible +1 –2 0 1 Improvement of symptoms occurred within
time frame relative to the drug intake? initial 5 days while complete resolution occurred
within a period of 2 months after medicine
Was there an initial aggravation of symptoms? +1 0 0 0 Not observed
Did the effect encompass more than the main symptom +1 0 0 1 There was improvement in mental generals
or condition (i.e., were other symptoms ultimately and physical generals as well
improved or changed)?
Did overall well‑being improve? (suggest using +1 0 0 1 Overall well‑being as there was no other
validated scale) illness during and after treatment
Direction of cure: did some symptoms improve in the +1 0 0 0 Not observed
opposite order of the development of symptoms of the
disease?
Direction of cure: did at least two of the following +1 0 0 0 Not observed
aspects apply to the order of improvement of symptoms:
• From organs of more importance to those of less
importance?
• From deeper to more superficial aspects of the
individual?
• From the top downwards?
Did “old symptoms” (defined as non‑seasonal and +1 0 0 0 Not observed
non‑cyclical symptoms that were previously thought to
have resolved) reappear temporarily during the course of
improvement?
Are there alternate causes (other than the medicine) –3 +1 0 1 In infectious conditions such a LA there are
that—with a high probability— could have caused the very low chances of improvement without
improvement? (Consider known course of disease, appropriate medicinal intervention.
other forms of treatment, and other clinically relevant
interventions)
Was the health improvement confirmed by any objective +2 0 0 2 Yes by Ultrasonography reports after every
evidence? (e.g., laboratory test, clinical observation, 15 days
etc.)
10. Did repeat dosing, if conducted, create similar +1 0 0 0 Not observed
clinical improvement?
Total Score=8

Figure 4: Ultrasonography- whole abdomen (11 August, 2020): showed

Figure 3: Ultrasonography - whole abdomen (27 June, 2020) showed mild
liver normal in size with resolving abscess
hepatomegaly with a hypo-echoic lesion. Spleen enlarged to a span of 14.8 cm

58 Indian Journal of Research in Homoeopathy ¦ Volume 16 ¦ Issue 1 ¦ Jan-Mar 2022

 Chhikara and Singh: Individualised homeopathy in a case of liver abscess

which suggests the causal relationship between homoeopathic sick parts alone. The notable reduction of pus in LA with
intervention and outcome in this case. the improvement of subjective symptoms is a documentary
evidence. This shows the strength of the Nature’s law of cure
Bryonia alba covered the mental symptoms well, such as
with single, simple medicine and signifies the importance of
timidity, anxiety about how he developed the disease, aversion
individualization in homoeopathic prescription. However,
to answer, wants to be quiet, rest; and worried about his work.
Also, the physical symptoms like desire for cold food and this is a single case study and LA can be associated with
drinks, unquenchable thirst for cold water, frequent urination, variable presentations in different cases. Well-designed
pain in the right side of the abdomen (right hypochondrium), studies maybe undertaken for scientific validation of these
desire for complete rest, pain better by pressure were also results.
covered by the medicine. As mentioned in the homoeopathic
literature,[8,9] the mechanism of action of Bryonia alba is such Declaration of Patient Consent
that it corresponds to fevers of almost all kinds, especially The authors certify that they had obtained all appropriate
rheumatic, typhoid, bilious and remitting. In these, as in all consent from the patient for his investigation reports and other
other complaints, the exquisite sensitiveness of the drug to the clinical information to be reported in the journal. The patient
movement of all kinds is a leading characteristic. was made to understand that his name and initials will not be
In the above case it is observed that though the natural published, and due efforts will be made to conceal his identity,
tendency of conditions with pus accumulations and but anonymity cannot be guaranteed.
abscesses is pain on touch and motion; in this particular
case, there was relief in the pain of the right hypochondrium References
region from pressure. Moreover, the patient entered the 1. Mischnik A, Kern WV, Thimme R. Pyogenic liver abscess: Changes
consultation room with his hand on the liver region and of organisms and consequences for diagnosis and therapy. Dtsch Med
remained in same posture during entire narration process. Wochenschr 2017;142:1067-74.
Thus, amelioration by pressure and complete rest being 2. Varanasi R, Nayak D. Homoeopathy in the management of infectious
diseases: Different facets of its use and implications for the future.
leading characteristics of Bryonia alba, guided us toward Indian J Res Homoeopathy 2020;14:110-21.
the remedy for this case. Furthermore, it is verified that 3. Hau T, Hartmann E. Pathology, diagnosis and therapy of liver abscess.
the amelioration from pressure is not applicable only for Zentralbl Chir 1987;112:529-47.
external impressions but internal manifestations as well. 4. Czerwonko ME, Huespe P, Bertone S, Pellegrini P, Mazza O,
Pekolj J, et al. Pyogenic liver abscess: Current status and predictive
The 200 C potency was found to be useful in this case. factors for recurrence and mortality of first episodes HPB (Oxford)
Only four doses of Bryonia alba 200 C were required for 2016;18:1023-30.
pus to resolve completely. Furthermore, the patient showed 5. Offline Radar Homeopathic Software 10.5.003, Development Platforms:
significant improvement regarding mental symptoms as well Windows Synthesis 8.1. Ver 8.1; 2010.
6. Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA. Features
as decreased anxiety related to his health as he could resume
distinguishing amoebic from pyogenic liver abscess: A review of 577
work. This case shows the effective role of individualized adult cases. Trop Med Int Health 2004;9:718-23.
homoeopathic medicine in treating LA when prescribed on 7. Lamba CD, Gupta VK, van Haselen R, Rutten L, Mahajan N, Molla AM,
the basis of homoeopathic principles. et al. Evaluation of the modified naranjo criteria for assessing causal
attribution of clinical outcome to homeopathic intervention aspresented
in case reports. Homeopathy 2020;109:191-7.
Conclusion 8. Clarke JH. A Dictionary of Practical Materia Medica. Vol. 1. London:
The Homeopathic Publishing Company; 1900. p. 311-9.
Successful treatment with homeopathy is attributed to the fact 9. Allen HC. Keynotes and Characteristics with Comparisons of Some of
that the treatment is individualized to each patient; remedies the Leading Remedies of the Materia Medica. 10th ed. New Delhi: B Jain
are given to treat the individual as a whole and not to his Publishers Pvt. Ltd.; 2006. p. 67.

Indian Journal of Research in Homoeopathy ¦ Volume 16 ¦ Issue 1 ¦ Jan-Mar 2022 59

 Chhikara and Singh: Individualised homeopathy in a case of liver abscess

Homéopathie individualisée dans un cas d'abcès du foie: Rapport de cas

RÉSUMÉ Introduction: Les abcès hépatiques sont des collections purulentes dans le parenchyme hépatique qui résultent d'une
infection bactérienne, fongique ou parasitaire qui peut s'étendre au foie par extension d'une infection adjacente, ou à la suite
d'un traumatisme. L'approche homéopathique, qui consiste à traiter la maladie en fonction de l'ensemble des symptômes, est une
alternative pertinente à la médecine conventionnelle, souvent insatisfaisante, dans les cas de LA. Résumé du cas: Un homme de
35 ans qui présentait un abcès du foie a été traité avec un médicament homéopathique basé sur la totalité des symptômes et une
amélioration significative a été constatée avec la résolution de l'abcès du foie, ainsi qu'un soulagement des autres symptômes.
Cela renforce notre conviction du potentiel de l'homéopathie individualisée dans le traitement des maladies infectieuses.

Individualisierte Homöopathie in einem Fall von Leberabszess: Ein Fallbericht

ABSTRAKT Einführung: Leberabszesse sind eitrige Ansammlungen im Leberparenchym, die durch eine bakterielle, pilzartige
oder parasitäre Infektion entstehen, die sich durch die Ausbreitung einer benachbarten Infektion oder als Folge eines Traumas
auf die Leber ausbreiten kann. Der homöopathische Ansatz, die Krankheit auf der Grundlage der Gesamtheit der Symptome zu
behandeln, ist eine sinnvolle Alternative zur oft unbefriedigenden konventionellen Medizin in Fällen von LA. Zusammenfassung
der Fälle: Ein 35-jähriger Mann, der sich mit einem Leberabszess vorstellte, wurde mit homöopathischen Arzneimitteln behandelt,
die auf der Gesamtheit der Symptome basierten, und es kam zu einer signifikanten Besserung mit Auflösung des Abszesses in
der Leber, zusammen mit einer Linderung der anderen Symptome. Dies bestärkt uns in unserem Glauben an das Potenzial der
individualisierten Homöopathie bei der Behandlung von Infektionskrankheiten.

लीवर फोड़ा के एक मामले में व्यक्तिगत होम्योपैथी: एक मामले की रिपोर्ट

परिचय: लीवर फोड़े लीवर पैरेन्काइमा में पीप संग्रह हैं जो बैक्टीरिया, कवक, या परजीवी संक्रमण के परिणामस्वरूप होते हैं जो आसन्न
संक्रमण के विस्तार से या आघात के परिणामस्वरूप लीवर में फैल सकते हैं । लक्षण समग्रता के आधार पर बीमारी के इलाज का होम्योपैथिक
दृष्टिकोण एलए के मामलों में अक्सर असंतोषजनक पारं परिक चिकित्सा के लिए एक प्रासंगिक विकल्प है । केस सारांश: लीवर के फोड़े के
साथ प्रस्तुत एक 35 वर्षीय पुरुष को लक्षणों की समग्रता के आधार पर होम्योपैथिक दवा के साथ इलाज किया गया था और लीवर में फोड़ा
के सुधार के साथ महत्वपूर्ण सुधार दे खा गया था, साथ ही अन्य प्रस्तुत लक्षणों में राहत में थी। यह संक्रामक स्थितियों के इलाज में व्यक्तिगत
होम्योपैथी की क्षमता में हमारे विश्वास को बढ़ाता है ।

Homeopatía individualizada en un caso de absceso hepático: Reporte de un caso

ABSTRACTO Introducción: Los abscesos hepáticos son colecciones purulentas en el parénquima hepático que resultan de
una infección bacteriana, micótica o parasitaria que se puede diseminar al hígado por extensión de una infección adyacente, o
como resultado de un trauma.El enfoque homeopático del tratamiento de la enfermedad basado en la totalidad de los síntomas es
una alternativa relevante a la medicina convencional a menudo insatisfactoria en los casos de LA. Resumen del caso: Un varón
de 35 años que presentaba absceso hepático fue tratado con medicina homeopática basada en la totalidad de los síntomas y se
observó una mejoría significativa con resolución de absceso en el hígado, junto con alivio en otros síntomas que presentaban.
Esto realza nuestra creencia en el potencial de la homeopatía individualizada en el tratamiento de condiciones infecciosas.

肝脓肿病例中的个体化顺势疗法: 一个案例报告
抽象的 简介:肝脓肿是由细菌、真菌或寄生虫感染引起的肝脏实质内的脓性集合，可由邻近的感染扩展到肝脏，或由
外伤导致。.在洛杉矶的病例中，以症状为基础治疗疾病的顺势疗法方法是一种相关的替代方法，而传统医学往往不
能令人满意。. 案例摘要: 一位35岁的男性患有肝脏脓肿，根据全部症状用同种疗法进行治疗，随着肝脏脓肿的消退
和其他症状的缓解，病情得到了明显改善。.这增强了我们对个体化顺势疗法在治疗感染性疾病方面的潜力的信念。.

60 Indian Journal of Research in Homoeopathy ¦ Volume 16 ¦ Issue 1 ¦ Jan-Mar 2022