CLINICAL CASE HISTORIES Trifolium pratense for breast disease: a case series E. Parvu, The Acupuncture and Homeopathic Centre, Bucharest, Romania Introduction Trifolium pratense is a familiar meadow herb, with reddish stem and three oval leaflets which grow on alternate sides of the stem and a purple ovoid flower head.[1] In the homeopathic materia medica Trifolium pratense is said to stimulate the secretion of the salivary glands, and to be beneficial to mumps and affections of the pancreas and to have anticancer effects.[2] Trifolium pratense is said to retard progress of cancerous tumours before ulceration has taken place.[3] In cancer an extract of the blossoms is used. [4] Boericke mentions it for cancerous diathesis. Allen described three provings in men. The provers produced much mucus in the throat and the nose. Modern studies confirm the antitumoral, anti-inflamatory and oestrogenic effects of Trifolium pratense. The isoflavones biochanin A and genistein present in the leaves have oestrogenic activity. Methanol extract of Trifolium shows significant competitive binding to oestrogen receptors alpha and beta. In cultured Ishikawa (endometrial) cells, Trifolium exhibited oestrogenic activity, as indicated by induction of alkaline phosphatase activity and up-regulation of progesterone receptor activity. In S 30 breast cancer cells, pS2 (presenelin-2) another oestrogen-inducible gene, was up-regulated in the presence of Trifolium pratense.[5] Isoflavones such as those found in Trifolium pratense may reduce the risk of cancer, including breast cancer.[6] There is an absence of scientific data on its mode of action when applied clinically on a herbal or homeopathic basis. The materia medica recommends the use of the mother tincture. I was concerned with the question of whether Trifolium pratense might have a role in the treatment and/or prevention of breast cancer. And, if so, what is the optimal potency? Another obvious question was whether Trifolium pratense might influence the level of oestrogens in patients with positive oestrogen receptor status? To investigate these questions I began with a proving on myself. One of my colleagues also agreed to take it (her mammography shows an inhomogenous area of 5 mm and dysplasia). I took 20 granules of Trifolium pratense 200c over 3 consecutive days and she took 20 granules/weekly for 6 weeks. The first observation was that both of us had early menses with decrease of the breast tension. For me the effect of Trifolium was similar to my previous experience with a single dose of Folliculinum, although milder and accompanied with general wellbeing. On the basis of this subjective experience I began to prescribe Trifolium pratense in ultramolecular potency in cases displaying hyperoestrogenia and high percent of oestrogen receptors (ER). The remedy was also administred in low potency to patients with a low ER family history of cancer. Case 1 BG age 48, female, retired on health grounds The patient was referred in April 2002 by her family doctor for treatment of rheumatic pain secondary to osteoporosis and muscle atrophy. Her current symptomatology was of 3 months duration. She was diagnosed with breast dysplasia in July 1997 on the basis of mammogram appearances. The report was as follows: ‘left breast—retroareolar—irregular lesion, diffuse 1.4×1 cm in keeping with dysplasia; upper medial quadrant, lesion of similar characteristics with calcification 2 cm; right breast—upper lateral quadrant, irregular opacity, inhomogeneous with projections of 1–3 cm.’ Contact infrared thermography, and neurovegetative reactometry in November 1999 also supported the diagnosis. The patient refused orthodox treatment. She self-medicated with herbs and homeopathic complexes prior to referral. In March 2002, she attended for follow-up mammography which was reported as follows: ‘left breast—mass 1.2 cm diameter retroareolar, dysplasic. Also irregular lesion in upper lateral quadrant. Right breast—irregular area 3 cm diameter, microcalcification, dysplasic appearance with increased vascularisation.’ First consultation 25.04.2002 At the time of her first homeopathic consultation the patient had the following symptoms: general twitching, muscular cramps, persistent fatigue, memory impairment, sluggish cognition, signs of depression, weepiness and emotional lability. She is a generally chilly person, thin appearance with blue eyes, fair complexion and unhappy expression. Significant past medical history includes: Hepatitis B infection, hypothyroidism, hypoparathyroidism, hyperoestrogenaemia, precocious puberty. There was a teenage crisis with attempted self-harm or para-suicide. The family history revealed that her mother suffered from Alzheimer's disease and died as a result of cerebro-vascular accident. On examination she had marked joint laxity. Breast examination revealed a congested, painful left breast with a palpable mass. Prescription: 20 granules of Trifolium pratense 200c single immediate dose Follow-up 13.05 2002 Within 24 h the patient experienced a reduction in breast symptoms, especially pain and tension. She felt the lump smaller on palpation. Two to three days after the remedy she had an early menstrual period. After a few days she could no longer feel the lump on palpation. She reports feeling very well. A pimple has appeared on the tip of the tongue. Mammography was arranged. Follow-up 17.06 2002 To my amazement the patient returned with the report that ‘mammography is normal’. The patient was septical about the result and blamed me for the fact that now she does not now have grounds for medical retirement! After a few days she was getting used to the idea that she really does not have a lump and returned in generally good health, asking for another dose of medicine. I refused her further treatment and suggested that she should try to find a job and begin to see herself as a healthy person. Follow-up 19.10.2002 No relapse of breast symptoms. Observations: In this case Trifolium appears to have acted as similimum. It was a most striking case. Case 2 TS 80-year-old female, retired, married First consultation 17.09.2002 She was brought to my practice with the diagnosis of invasive ductal breast carcinoma. The patient was an elderly lady who completely refused conventional treatment, saying ‘It doesn’t matter at my age.’ She is slim, cheerful and optimistic in spite the fact that her son died few years ago of lung cancer. She was a teacher and rather fastidious. Throughout her life she had been quite healthy, with no significant past medical history. Life has not been easy for her: she was a refugee during the Second World War and her father died of cancer. Mammography shows an ‘inhomogenous opacity in the left breast, with dull outline, size 3/4 cm retromammeolar. Nodular and ductal calcification’. Physical examination revealed that the axillary region was free of nodes. There was visible retraction of the left nipple, and a large area of ecchymosis following recent needle biopsy. The needle biospy showed a large number of separated cells, intense local haemorrhage distributed within an irregular lesion with cytological characteristics of invasive ductal carcinoma. Haematology was unremarkable. Prescription: I decided to treat her with Trifolium pratense, taking into consideration the age of patient, the predisposition and prognosis. I placed less emphasis on the hormonal aetiology. She was instructed to take a single dose of Trifolium pratense 12c every day for 1 month. Follow-up 15.10.2002 The patient remained in excellent general health: sleeping well, with good appetite and no pain. She remains optimistic. The local bruising has disappeared. On palpation the lump seems to have reduced. She continued the treatment with Trifolium pratense 12c for a further month. Follow-up 17.11.2002 She continues to feel fine. On examination there is retraction of the left nipple. The breast shows no signs of inflammation or ulceration. The small lump remains palpable. I prescribed Trifolium Pratense 30c twice weekly/one dose for a further month. Follow-up 20.12.2002 Ultrasound indicated a decrease of the lump size from 4 to 2.5 cm diameter dendriform projections 6 mm, no axillary adenopathy. Locally there were no sign of inflammation or ulceration. She feels well in herself with normal appetite and no weight loss. She continued the treatment with Trifolium 30c and Viscum album 7c, daily/one dose. Follow-up 07.04.2003 Ultrasound showed decrease of the lump to 1.5 cm diameter, no axillary adenopathy. Feels fine, optimistic. Prescription: Viscum album 7c daily/one dose, Arsenicum album 7c daily/one dose. Follow-up 28.07.2003 Stationary. Ultrasound lump shows 1.5 cm with dendriform projections. Problems in family with her husband. Prescription: resume Trifolium 30c once a week. Follow-up 04.09.2003 I met her daughter-in-law. She said that her ex-mother-in-law feels fine. Is optimistic and full of energy. Case 3 PA 24-year-old female, student, recently married First consultation 27.10.2002 This young lady attended with her mother, who was an old patient and friend of mine, with a distressing diagnosis. Left mammary neoplasm stage II ( T2, N1, Mo) superior lateral quadrant. She was then 5 days post operation (hemimammectomy). Histopathology revealed invasive papillary carcinoma, with chronic inflammation, axillary node invasion, large areas of necrosis with calcification. The prognosis was poor. Immuno-histochemistry: Oestrogen receptor positive 30%, progesterone receptor positive 40% , Cerb B2 local positive (++). The patient was pale and appeared to be in emotional shock after the operation. She was suffering from post-operative pain. She is a graduate of the Finance University, very recently married, without children. Her father died 2 years ago after suffering from multiple sclerosis for 15 years. She had been close to him and suffered a lot after he died. In addition to her ongoing grief, she was very worried about the prospect of oophorectomy and subsequent infertility, since she desperately wanted a child. She has a melanoma on the face. Three years previously I had given her Lycopodium clavatum for digestive problems and exam nerves. Prescription: Arnica montana 7c for 2 weeks. Follow-up 14.11.2002 Following Arnica the wound healed and her pain was alleviated. I then prescribed Trifolium pratense 200c 20 granules single dose with repetition after 1 month. Three days after the remedy she had an early menstrual period, and felt better in herself. Emotionally she was more accepting of the idea that she has cancer. Follow-up 15.12.2002 Looking better and feeling more optimistic with good appetite. She intends to continue the conventional treatment: five pulses of chemotherapy and a course of radiotherapy. The oncologists were of differing opinion with regard to oophorectomy. I agree with the prevailing opinion that she should wait. Further dose of Trifolium pratense 200c. Follow-up 15.01.2003 Call from her mother, after the first course of chemotherapy, her haematology show less than 1000 white cells, although the patient felt quite well. I recommended Echinacea and a further dose of Trifolium pratense 200c and asked her to keep in touch. She also continued conventional treatment. Follow-up 23.04.2003 After chemotherapy she felt nausea, relieved by Nux vom 5c. She continued with one dose of Trifolium pratense 200c monthly. Follow-up 06.07.2003 She feels better. More energetic after Trifolium pratense especially after she finished the chemotherapy. No relapse of breast symptoms. Continue with one dose of Trifolium 200c every month (she took it seven times). Case 4 CP 66-year-old female, retired First consultation 15.09.2002 This patient was referred to me by an oncology specialist with the diagnosis of left mammary neoplasm stage III with lymphoedema of the left arm following radical mastectomy. The procedure was of Madden type with ablation of the left axillary lymph nodes, undertaken on 21.12.2001. By the time she was referred, the oncologists and surgeons felt that they were running out of therapeutic options. At the time of her first consultation the left arm was hard with oedema of 2 months duration and discoloured purplish-blue. Although the onset had not been associated with pain, fever or local heat, she had received antibiotics and anti-inflammatory drugs for possible cellulitis. This did not result in any improvement. Her current drug regime was Tamoxifen and Detralex, she has had four sessions of chemotherapy and 25 sessions of radiotherapy. Personal history: Cholecystectomy, Non-insulin-dependent diabetes (1995), congenital malformation left hand, with muscular atrophy, menopause 1989. Family history: Mother died at 83 years with hypertension, father died of lung cancer. She is married and has two healthy boys. Homeopathic history: Chilly but also general aggravation in sunny weather with heavy perspiration on the back and neck, good appetite, no special desires or aversions. Sometimes she has hot flushes, she is easy upset emotional. She is weepy and feels depressed and hopeless, yawning frequently. She is using Bromazepamum for sleep. She is significantly overweight. Prescription: I prescribed three doses of Trifolium pratense 200c at 12-h intervals, hoping to improve the mental status of patient rather than with the expectation of improving the oedema of her hand. Follow-up 03.10.2002 After a week she felt generally better, more energy, she was able to do some homework. The oedema was reduced by 0.5 cm in circumference, the skin was not so tense. She was noticeably less weepy. Follow-up 15.11.2002 Good general status. She complains of insomnia. No further change in lymphoedema. I gave her Apis mellifica 7c daily/one dose for a month. Follow-up 15.12.2002. No decrease of lymphoedema. Very depressed, insomnia, yawning, weeping and laughing. I repeated another dose of Trifolium pratense 200c stat, and Ignatia 30c stat. Follow-up 28.12.2002 Feels a bit better in general, better sleep. Wearing red, more cheerful. No improvement of lymphoedema. Case 5 CL 45-year-old female, accountant, married First consultation 20.07.2002 This lady was diagnosed with breast cancer in November 2000 (left side, stage II, without lymph node invasion). She was treated with chemotherapy and radiotherapy. In April 2001 she had a relapse, lump 10–12 mm treated by radical mammectomy, chemotherapy and radiotherapy and Tamoxifen. In April 2002 the cancer had spread further: An amorphous mass 10–15 mm was found in the upper external quadrant of the right breast. She attended my practice following the second pulse of radiotherapy and chemotherapy (20 day interval between pulses). She complained of nausea and vomiting and had elevated transaminases. Family history: Mother died of breast cancer, father of cerebro-vascular accident. Personal past medical history: Hepatitis. A lady with black hair and dark eyes. She was peri-menopausal with slight vasomotor flushes, especially at night. She expressed suspicion about the efficacy of the homeopathic treatment without much optimism. She associated the appearance of the recent lump with injury from an elbow blow. She is sensitive to heat. She was due to have her final radiotherapy treatment the same day. Prescription: I prescribed Trifolium pratense 200c once monthly, Conium maculatum 7c daily/one dose for a month and Sepia officinalis 30c, once weekly. Follow-up August 2002 The mammography shows no evidence of a lump in the right breast and no sign of inflammation. The patient was in good general health. In spite of positive indicators the surgeon denied the effect of homeopathic treatment and proposed further surgery and chemotherapy. There was no further homeopathic follow-up. Case 6 BC 35-year-old female, receptionist First consultation 09.10.2002 This patient was referred to me in November 2002 with the diagnosis of cystic mastopathy with left breast cyst 1.3 cm and uterine fibroma (3 cm). In 1995 she was diagnosed with pulmonary tuberculosis. She still has rheumatic pain and acne with facial hirsutes following anti-tuberculosis chemotherapy. She also complains of leucorrhoea. She is uraemic with intense itching, breast tension and pain before menses. She also experiences hot flushes. ‘I feel as though I have reached the menopause’. The menses are irregular, painful, with a protracted cycle of 40–45 days. She is a unmarried, very sensitive and emotionally vulnerable. She lived for a long time in Italy and worked as receptionist in a hotel. She is involved in an unhappy love affair. Family history: Alcoholic father, TB in past generations and a strong family history of cardio-vascular problems, mother has cardiac problems, parents divorced. She is a chilly person, except for momentary hot flushes. She does not have special food desires or aversions. She feels generally better in the mountains. Seems emotionally unstable. Prescription: Trifolium pratense 200c single dose, on the basis that it appears to be indicated in hyperoestrogenaemic states. Five days after the remedy she called me to say that she feels that there has been a great improvement, no pain or tension in the breast ‘ I can’t remember how long it has been since I was last free of breast pain’. On palpation the cyst seems to be smaller. Follow-up 12.11.2002 After a month she still feels better, with increased confidence and general wellbeing. There has been a great amelioration of her acne and no hair on her chin. Normal menstruation. Follow-up 10.12.2002 Following the break up of her unhappy relationship, the breast symptoms relapsed. This was accompanied by severe pain in the left breast and a milky secretion from the nipple. Her menstrual flow was diminished and delayed. She then received Trifolium pratense, 200c powder in gelatin capsule, single dose, Tuberculinum 10 M, one dose to be taken over 10 days. Follow-up 22.12.2002 She reports that after the Trifolium pratense capsule she does not feel the same effect as after the granules. She still has pain in the breast and delayed menstruation. In spite of the symptomatology the mammography shows a reduction of the size of the cyst from 13.5 to 4 mm. She received a further dose of Trifolium pratense 200c, single dose Follow-up 22.01.2003 Two days after the granules she had menstrual period without pain. She reports feeling well. There is no pain or tension in the breast. Case 7 CA 48-year-old female, shop assistant First consultation 15.01.2002 The patient was referred to my practice with the diagnosis of fibrocystic mastitis, and a left ovarian cyst. She also complained of digestive problems; sensation of a lump in the stomach; bloated abdomen and heartburn after meals; chronic sinusitis with headache on the left side. Past history: In 2000 she underwent hysterectomy with preservation of adnexae for fibromyoma and dysmenorrhoea. Ultrasound imaging, 2 months after surgery, revealed an ovarian cyst 3.8×3.7 cm. Family history: Mother had cholelithiasis and hepatitis, father unknown, married, two healthy boys. She is a chilly person, pessimistic and anxious, sees everything from the blackest standpoint. Desires fruits, oranges and lemons, sour. Aversion to milk and apples. She has a strong fear of cancer. Her sleep is good. Prescription: Sepia officinalis 30c two doses, 200c single dose, Oophrinum 7c daily/one dose. Follow-up 27.03.2002 On echography the ovarian cyst was found to be decreased in size to 2.6×1.3 cm. The breast symptomatology, discomfort, pain, tension increased. Mammography showed a homogenous lump 2.6 cm in the right breast. I considered that she might be pre-menopause hyperoestrogenaemic and prescribed Trifolium pratense 200c single dose. Follow-up 25.08.2002 Ultrasound—ovarian cyst 2.3 cm. Amelioration of pain and breast tension ‘I feel much better, it was like I had another breast under my axilla, all this now gone… for four months…in the past, I felt breast tension every month; My neighbours used to say that I spent all my time at the doctors…I have boys who will take care of me when I am old…’ Follow-up 20.01.2003 No important problems. In general she feels well. She only experiences some musculo-skeletal pain in the right shoulder. Successfully treated with Bryonia and few session of acupuncture. Case 8 GE 25-year-old female, office assistant. First consultation 3.09.2002 The patient complained of amenorrhoea for the past 3 months, anovulatory periods, hirsutism, cystic breasts. She took the oral contraceptives Logest and Duphaston which she does not tolerate because of menorrhagia. She also has a strong sensation of heat with perspiration, headache in the morning and evening after emotional stress. The laboratory investigations show low level of progesterone and oestrogens with high level of testosterone. Personal history: Frequent urinary infections. Cauterisation of the cervix. She has always had irregular menses without pain. Family history: Grand mother had breast cancer: mother—history of anaemia. She is thin and sensitive, introverted, serious, dislikes sympathy, feels better alone. She has a boyfriend in Japan and plans to get married and have children. She likes salt, sour; dislikes milk and fats, the seaside, warm weather. Sometimes sleeplessness, restless sleep, dreams of children and high places. Prescription: The homeopathic case taking suggests Natrum muriaticum. She received Natrum muriaticum 30c, two doses, 200c single dose at 12-h interval; Folliculinum 30c, 3 doses at 24-h interval, then Progesterone 7c, daily/one dose for 7 days. Follow-up 25.10.2002 Amenorrhoeic after a month of treatment. I gave her Trifolium pratense 200c/20 granules single dose Follow-up 27.11.2002 The second day after Trifolium she menstruated, with great amelioration of the heat sensation and headache. She looks more open and is socially more at ease. People around her notice a change in her. Further dose of Trifolium 200c. Follow-up 15.12.2002 Normal oestrogen levels. No hot flushes, headache much better. A bit anxious, but optimistic thinking about her plans to travel to Japan to see her boyfriend. Follow-up 14.07.2003 Well, married. Regular menses. Discussion In Clarke's Material Medica the main clinical indications for Trifolium Pratense are: Cancer, Constipation, Cough, Mumps, Pancreas, affection of, Throat, sore; mucus in, Uvula, pain in. My clinical experience show that we might add some other indications including: Cystic mastosis, Breast cancer with positive oestrogen receptors, Hyperoestrogenia, Amenorrhoea, Ovarian cyst. In the literature there is no clear mental picture of the remedy. The patients that usually seem to have indications for this remedy have emotional problems and sometimes the disease can be a refuge for their unhappiness. I suggest a new rubric: Mind—refuge in disease. There is an absence of scientific data on its mode of action when applied clinically on a homeopathic bases and more research is needed. Acknowledgements Thanks to Dr Russell Malcolm, Dr Peter Fisher, Dr Liz Thompson, Dr Robert Mathie. doi:10.1016/j.homp.2003.09.001 Homeopathy Volume 93, Issue 1 , January 2004, Pages 45-50 J Homepathy, 1/04 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.