Healing Autism with Homeopathy in Synergy with Other Therapies

Last modified on November 13th, 2018

autism

After a discussion of the basic principles of homeopathy, Dr. Rajalakshmi presents summaries of four cases of children with developmental disorders, to illustrate the potential for treating these problems.

autism.jpgAbstract:

Autism and Pervasive Development disorders have reached epidemic proportions in recent years. In such a situation it is important to find different and innovative treatments and interventions that will help in reducing the severity and complexity of the disorder and help the child reach an optimal level of functioning. There is a need for an integrative and multidisciplinary approach to heal the child with autism. This is where homeopathic treatment for autism can help. This paper will discuss the beneficial effects of homeopathic treatment for autism with case studies. This will also incorporate feedback from parents on the changes seen in the child after treatment. This paper will also throw light on the homeopathic system of medicine and help dispel certain misconceptions.

Introduction:

Homeopathy is a system of therapeutics that is based on the law of similiars, Similia Similibus Curanter. In other words ‘what can cause can cure’. Substances that can cause symptoms in healthy individuals are used to treat the very same symptoms in a diseased individual.

Dr. Hahnemann who was a highly successful conventional medicine doctor first discovered this principle after going through ancient writings and his experiments upon himself. He first started with experiments with cinchona bark. Hahnemann continued doing experiments with different substances that helped to verify this theory.

One more interesting fact to be noted is that the ‘law of similars’ finds mention in several ancient systems of medicine. This system was also adopted by Hippocrates and Paracelsus. We see the basic principle of homeopathy being quoted in ancient Ayurvedic texts such as “vishasya vishemevam aushadam” and “samaha samena shantihi.”

It is important to understand how the homeopathic model is different. Homeopathic remedies act in a dynamic way by stimulating the natural defense mechanisms of the body. In homeopathic treatment the medicine just acts as a stimulus and the system heals itself by throwing out the disease force or in other words it provides the impetus needed for the system to recover.

Symptom matching is done with a view to finding a remedy that is exactly able to reproduce the child’s symptoms, and when introduced to the system it repels or neutralizes the actual symptoms. Since homeopathy acts at a nano level, the effects of the remedially induced symptoms just pass away leaving the system disease free and healthy.

Every substance in nature can be supposed to have an electromagnetic field. A remedy that works on a dynamic plane (in homeopathy a process known as potentization brings out the energy in the substance and helps the electromagnetic field to increase to the level where it can act at a dynamic level) is selected and usually the strength is such that it resonates closely or is at the same frequency as the body’s electromagnetic field. This resonance is what helps the body recover.

Recent researches by scientists from different fields like engineering and materials sciences have helped improve know ledge about the way homeopathic remedies act and help dispel the notion that homeopathy works because of the placebo effect.

Principles of Homeopathic Treatment

  1. Doctrine of Vital Force: Homeopathy believes in the concept of the vital force. This is somewhat similar to the concept of pranashakti in Ayurveda. Every organism has an electromagnetic energy field that keeps it animated. It is this vital force that is present in every cell of the body and that gives it life. Homeopathic treatment is targeted at this dynamic plane that may be deranged when there is disease. When the derangement in the vital force is set right, it helps in self healing at the physical level.
  1. Potentization: Homeopathic remedies are prepared by a process known as potentization. In this process remedies are not merely diluted but energized to bring out their medicinal properties at a nano level.
  1. Law of Simplex or Single remedy: Only one single remedy is used, based on symptom matching and individualization.
  1. Individualization: Homeopathy believes in treating the patient not the disease. Homeopathy believes in the concept of each individual being unique with specific characteristics. Even identical twins are not similar in all aspects. The way the same disease manifests will be different in different individuals.
  1. Law of Minimum dose: The remedy strength is adjusted such that it is only slightly stronger than the disease force to avoid unnecessary aggravations.
  1. Doctrine of Drug Proving: The curative action of substances are verified through the process of drug proving. These substances are administered to healthy individuals and the symptoms produced are recorded.
  1. Hering’s Law of Direction of Cure- All cure starts from within outwards, from more important to less important organs, from above downwards and in reverse order of  appearance. For example: There was a recurrence of dermatitis that the child had as an infant in a child with autism with consequent relief of behavioral symptoms.

Chronicles of Children

The following are some illustrative chronicles of children. I have chosen four children as a representative sample. Out of the four children (three male and one female), three of the children were completely non-verbal and one child had no meaningful speech. One child had a diagnosis of Autism Spectrum Disorder (ASD) with Attention Deficit Hyperactivity Disorder (ADHD).  The female child had a diagnosis of ASD and suspected Rett’s Syndrome after extensive chromosomal testing. The third child had a diagnosis of Pervasive Developmental Disorder (PDD) and the fourth child was severely autistic.

When families come to me they already have gone through extensive evaluations which are very useful in remedy selection along with detailed homeopathic case taking and observations.

The symptoms of the children have been divided into two parts. The first part lists the common symptoms or symptoms common to the syndrome of autism and the second part lists the peculiar, queer, rare and strange symptoms or the PQRS symptoms as it is called in homeopathy. The PQRS symptoms are the ones that help in remedy selection and help identify the unique manifestations of autism in each child. The following chronicles are condensed versions of the symptom picture. The homeopathic case history proforma incorporates the developmental landmarks including the emotional and physical state of the mother during pregnancy and all the major events in the child’s life apart from the usual elements of case taking. The first sitting usually takes from one to one and a half hours.

Chronicle 1: Master K, 4 years, Male: ASD with ADHD

K was first brought to see me when he was four years old. He was diagnosed with ASD with ADHD. The major concerns that the parents had were his extreme hyperactivity and his delay in language development. He also had poor eye and very poor attention span. Intelligence and grasping capacity were good though he was extremely impatient and would finish the tasks in a hurry. He was obsessed with numbers and extremely good at math. He was not imitating and had problems with social interaction and group activity. He had periods of absences with a normal EEG pattern. He had poor sleep patterns.

The characteristic symptoms were, he was very stubborn and adamant, could not take no for an answer. He would be better off if ignored and left alone when angry or upset. His sense of hearing was very acute. In the clinic he would suddenly stop what he was doing and seemed to be listening intently to sounds or voices what others in the room could not hear. He tries to hug and cajole parents to avoid being scolded or taken to task. He is a very curious and inquisitive boy. He had a fear of the dark and a peculiar dislike to dark people. He also would be scared if he sees a black veil or even of a black colour. This had extended to the level of dislike of ads featuring dark people. He prefers being with men and actively avoids being with girls

Homeopathic Remedies Used and Changes Seen

The following is a brief description of some of the remedies used based on the presenting symptom picture of the child. When a remedy is prescribed in classical homeopathy as mentioned in the law of direction of cure, there is a reversal of symptoms and you keep going back to the point where it all started. The ideal situation is when you reach the core where there is complete health and no derangement of the vital force. Although this is a very difficult proposition, it is at least possible with homeopathy to bring the system to an optimal level of functioning with minimal distress to the patient. This is why in homeopathy you can see old symptoms especially physical symptoms returning with relief of the mental or psychological symptoms. The old symptom also passes away without causing any distress.

The direction of cure proceeds from more important to less important organs and in the reverse order of appearance. This is the reason why we see transitions from the intellectual/cognitive to the emotional and from the emotional to the physical domain when a child is on homeopathic treatment. I have mentioned only a few remedies that have been used in order to highlight the process involved in homeopathic treatment and the transition from one remedy to the other based on the monthly reviews. The remedies mentioned are not in chronological order.

The leading indications mentioned are the symptoms produced when the remedy is administered to a healthy individual. When this symptom record matches with the symptom picture of the child it helps to neutralize the disease symptoms when administered based on the similar remedy. The homeopathic treatment and the changes seen in the below mentioned chronicles of children were seen in the span of one year of homeopathic treatment. The ages mentioned are the age at which treatment was started.

Master K: Sample of Homeopathic Remedies Used and Changes Seen

Pulsatilla (Wind Flower)

Leading Indications:  Weeps easily. Timid, irresolute. Fears in evening to be alone, dark, ghosts. Likes sympathy. Children like fuss and caresses. Easily discouraged. Morbid dread of the opposite sex.  Highly emotional. Peevish, Wants to have his way,  but  mild, gentle, yielding disposition at  other times, Great  sensitiveness, Sleep disturbed until midnight

Changes Seen : Improvement in response to commands, better understanding, sits and listens to stories, hyperactivity slightly better but persists, fear of black color still present  but colours with black, improvement in communication and clarity of speech, awareness of environment,  decrease in obsession with numbers

Belladona (Deadly Night Shade Plant)

Leading Indications:  Impatient, Tearing things, lives in a world of his own, coryza with cough, likes water play, speech wanting, wants to keep changing clothes

Changes Seen:  Repeating  school activities  at home, better emotional response in school, good speech but poor narrative abilities,  completes jigsaw puzzles very fast and is also able to verbalize how he does it, cough better

Lycopodium (Club Moss)

Leading Indications: Writing Difficult, Concentration Difficult, Hyperactivity, Anger, Restless, Excitability, Respiratory symptoms

Changes Seen:  Improved Concentration, reduction in restlessness, is able to converse well in mother tongue, good report from school

Chronicle 2: Miss Ar, 2.7 years: ASD (?Rett’s Syndrome)

When I first saw Miss Ar. she was extremely restless and hyperactive and was not paying any attention to the therapist’s instructions. She had constant midline movements. The major parental concerns were delayed milestones, problems with gross motor activity, hypotonia, difficulty squatting, standing and climbing stairs, poor fine motor skills, delayed language development, hyperactivity, stimming-midline movements, hand flapping, poor response to name calling, poor attention span, impatience and sound sensitivity

The characteristic symptoms were, sensitive mentally and physically and easily affected by environmental changes. She was a cheerful child. She was attention seeking and would get upset if conversations are not centered around her. She was hyperactive but also hyposensitive in the tactile (touch) and proprioceptive (balance) domain. She was adamant and extremely possessive about her mother. She needs to be consoled when upset. She loves dressing up and looking at herself in the mirror. She needs constant praise and appreciation. The other peculiarity was that though she likes loud sound she could not tolerate mixer /blender noise. She has an acute sense of hearing, can hear even distant sounds even if it is very faint. She has an obsession with music, works well if music is played. She had poor sleep patterns and head sweating.

Miss Ar, Homeopathic Treatment, Sample of Remedies used and Changes Seen

Calcarea Carb (Calcium Carbonate)

Leading Indications:  Delayed milestones, late learning to walk, fair fat and flabby, sensitive mentally and physically, attention seeking, sensitive to shrill sounds, rudeness, problems with gross motor activity, frequent tendency to catch cold

Changes Seen: Comprehension is steadily improving – she understands  and responds to sit, stand reasonably,  school and friends at school ( she regularly goes to a play-home nearby) , repeats the last word of a conversation , she speaks a lot of jargon-speech, few meaningful, mostly meaningless, she manages to stand from sitting on the floor which is a big improvement, she sleeps somewhat  better than before, her temper tantrums have gone up , Cough with rattling in the chest

Silicea (Grit)

Leading Indications: Imperfect assimilation and consequent defective nutrition. It goes further and produces neurasthenic states in consequence, and increased susceptibility to nervous stimuli and exaggerated reflexes. Lack of vital heat. Prostration of mind and body. Great sensitiveness to taking cold

Changes Seen: She has become more vocal, repeats a lot of words after us. She tries to string together words with a lot of effort though and appears to be attempting to narrate something to us. She has taken to licking all kinds of surfaces, Her sleep has become more disturbed, while her appetite has improved well, She crosses obstacles with much more confidence and it appears she is gradually giving up her fears, She seems to enjoy cartoons in TV, which is  new and comprehends well, Follows commands better. Head banging has increased, tantrums have increased. She does not still grip things too well.

Pulsatilla (Wind Flower)

Leading Indications :  Attention seeking, obstinate, Weeps easily. Timid, irresolute, Thirstless, Peevish, Chilly, Likes sympathy. Children like fuss and caresses

Changes Seen : Started to speak meaningful phrases , regular rashes appeared not only on her legs it was all over her body except face & head, able to sit on stool n benches which does not support her back , she climbs staircase with minimum support , self stimulatory behavior (hand stims ) have reduced ,better response to name, improved peer interaction, improved sleep patterns, acute of hearing still persists ,able to squat and sit on her haunches

Chronicle 3: Master Ad, 3yrs: PDD

Master Ad’s parents first ed me when he was 3years old. He was diagnosed as PDD-nos.  The major parental concerns were delayed language development, poor receptive and expressive language ability, hyperactivity, poor eye , poor concentration and attention span, temper tantrums, sound sensitive, poor response to name call, difficulty with certain gross motor activities

The characteristic symptoms were stubborn, adamant, cannot take no for an answer. The mother says that if anger is expressed through face expression he used to throw things & pulls mother’s hair, lie down on floor and cry, if anger is expressed through verbal scolding, he would lie down on floor and start crying, feels better with consolation. Attention needs to be diverted in some other activity. Extremely sound sensitive even to the sound of toilet flushing, tactile sensitivity cannot tolerate sticky things in hands like clay etc. Temper tantrums-he would throw things out if he was not allowed to do things he liked, desires company. Sensitive to music, stimming when unoccupied. Hypersensitive to vestibular movement, afraid to sit in the swing, cannot tolerate swinging movements even in the lap.

Master Ad: Sample of Homeopathic Remedies Used and Changes Seen

1. Silicea (Grit)

Leading Indications: Sound Sensitivity, Stubborn, Constipation, Irritable, Timid, Temper Tantrums, Crying from change of tone

Changes Seen: Started using 2 words sentences, Started saying mamma, papa, mama, nani, Sensitivity to vestibular movement has gone down drastically, Sensitivity to noise has reduced, Language comprehension seems to be improved, Better response to name call, eye has improved a little bit, Temper tantrums are more and he has become more stubborn, Scratches others (more with parents) with nails a lot, pushes kids younger than him, seeks for attention and affection from teacher and other kids, desires for milk, wheat products and chocolate.

2. Sanicula Aqua (The Water of Sanicula Springs, Ottowa, Illinois)

Leading Indications: Child headstrong, obstinate, cries and kicks, cross, irritable, quickly alternates with laughter, does not want to be touched, Constantly changing his occupation, head and neck of children sweat profusely, stool hard, impossible to evacuate

Changes Seen: Likes to be other kids but does not know how to respond to them, parallel play is present, doesn’t sit continuously in the class, keeps going out, touch sensory issue, does not like anything sticky on his hands, not able to hold pencil properly, Able to do coloring with crayons but not within picture boundary, eye has improved and scratching/pinching also has reduced a lot, temper tantrums have gone down, asks for things/toys which he wants us to take out, Response to name call has improved. Echolalia is same as last month. Perspiration is more in specific parts of body like around neck

3. Zincum Met (Zinc Metal)

Leading Indications: Nervous and extremely sensitive, excitable, trembling, tearing pains along the course of the nerves, tingling, excited on the least provocation, Head and scalp sensitive to touch, brushed, or having hair cut, repeats the question first then answers

Changes Seen: Eye when in the mood, understanding and comprehension better, wants to read or saying things, repeating songs and stories he reads, makes movie or product names, likes coloring and drawings, sensitiveness to teeth brushing and hair cut has come down, fear of getting hurt.

Chronicle 4, Master S, 4 years: ASD

Master S’s parents first consulted me when he was 4years old. He was diagnosed to be severely autistic at the age of 2years. The major parental concerns were very slow development in all areas. Delayed language ability, poor cognitive abilities, poor receptive language and no expressive speech, poor gross motor skills, poor fine motor skills, poor social skills and poor self help skills. Poor attention span and focusing ability, Periods of absences, stares into space or at lights, throughout the day. Disturbed sleep cycle, wakes up in the middle of the night and does not go back to sleep easily. Poor social interaction, sound sensitive, obsessed with spinning objects

The characteristic symptoms were temper tantrums only when he wakes up in the middle of the night, wakes up suddenly has a tantrum and then goes back to sleep again, bites and pinches when angry or very tired. Wants to be consoled, does not watch T.V, prefers to be alone but will come looking for people when he wants something, sensitive mentally and physically even to change of tone, history of frequent ear infections and stomach issues, flatulence, bloating of abdomen, tendency to dry skin with eczema like patches.

Master S: Sample of Homeopathic Remedies Used and Changes Seen

1.Natrum Carb (Sodium Carbonate)

Leading Indications: Nervous exhaustion, Late learning to talk, dry skin, delayed milestones, weakness of mind, sensory issues, Timidity, Estrangement from individuals and from society, tendency to ear infections

Changes Seen: Able to imitate a few sounds, doing better cognitively, he is in a one-on-one classroom and   his work in class has improved since then

2. Manganum Aceticum (Manganese Metal)

Leading Indications: Peevishness and taciturnity, with concentration in self, Low-spirited and reflective, Fretful, Not pleased with joyous music but immediately affected by the saddest, Abstraction of mind, Dullness of the senses, Touch sensitivity better pressure

Changes Seen: Fine motor skills have also improved slightly, he can color with help, string beads independently, use a spoon (with help) to feed himself, Understanding of language has also improved. He can understand many one step and some two step commands

Schematic Representation of Changes in Autism Treatment Evaluation Checklist (ATEC) Scores: Baseline and after One Year of Treatment

The following graph indicates the reduction in ATEC scores in the above mentioned 4 children after 1 year of treatment.  The Autism Treatment Evaluation Checklist measures four different areas- Speech, Language and Communication Skills, Sociability, Sensory/Cognitive Awareness, Health/Physical and Behavioural issues. It helps monitor progress with treatment. Higher scores indicate more severe problems and lower scores indicate reduction in severity.

The following is the scoring key for the ATEC:

  • ATEC < 30. This level places the child in the top 10 percentile. A child with score of less than 30 – or, better still, less than 20 – would have some ability to conduct normal, two-way conversations, and more or less behave normally. Such children have high chances of leading normal lives as independent individuals.
  • ATEC < 50. This places the child in the 30th percentile level. The child has good chances of being semi-independent. More importantly, he or she will not likely need to be placed in an institution or “nut house”. For many parents of autistic children, being able to achieve improvement up to this level is already considered very significant.
  • ATEC > 104. Even though the maximum score is 180, any person with a score of more than 104 would already be in the 90th percentile, and be considered very severely autistic.

Rajlaxmijan2015graph2

Benefits Seen After Homeopathic Treatment

  1. Reduction in hyperactivity
  2. Improvement in sitting tolerance/attention span
  3. Improvement in sensory perceptual skills and sensory integration
  4. Appropriate expression of emotions
  5. Improvement in both fine motor & gross motor abilities
  6. Improvement in social skills/eye
  7. Improvement in speech, language & communication skills
  8. Reduction in anxiety states/temper tantrums
  9. Improved sleep patterns
  10. Improved Immunity and resistance to infections

Discussion:

The chronicles mentioned above are just a small sample of the children that have been seen in the clinic and benefited from homeopathic treatment.  More than 150 children have been seen from 2002-2011 both in the clinic and through online consultations. There have been children from U.S.A, Dubai, Singapore, Bangladesh, U.K and other countries. It has been possible for a number of children to be integrated into mainstream schools after homeopathic treatment.

In one child who was 2.5 years, the initial speech  evaluation before starting treatment showed  the speech language ability to be that of an 11 month-old child and after treatment for a year when reevaluated the  speech language ability had improved to the level of a 2.7 year old child. The fact that the changes happened after just 1year of homeopathic treatment along with other therapies is significant.

This is not to discount the beneficial effects of speech therapy and occupational therapy but to highlight the fact that homeopathic treatment helped to accelerate the process and time involved for changes to happen. This is also noteworthy due to the fact that it generally takes longer for such improvements to be seen with only occupational therapy and speech therapy.  There have been instances where children who are nonverbal have started to communicate spontaneously after 1-1.5 years of homeopathic treatment when parents bring them for treatment at an early age.

In my work previously as a consultant to special schools, I have had the opportunity to see the differences in children who have been on homeopathic treatment and children who are not on treatment. These children were at the same level when treatment started and I found that the children who were not on treatment were still grappling with the same issues when I first saw them whereas there were significant improvements in social interaction, eye , reduction in hyperactivity, reduced temper tantrums and better communication skills in the children who were on homeopathic treatment.

A recent study was conducted by Dr. Praful Barvalia, a Homeopathic Physician from Mumbai with a large sample size of 123 children with ASD treated with classical homeopathy. This was an extramural research sponsored by AYUSH Department, Ministry of Health and Family welfare.  Further research needs to be undertaken to verify these facts and create an evidence base for the beneficial effects of homeopathy in children with autism.

Note: This was from a  presentation given at the Global Autism Convention from May 2011,at the NIMHANS convention centre in Bangalore, Karnataka India organized by Rotary district 3190 in association with St.John’s Hospital.

 

References:

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed. 4. American Psychiatric Association, Washington, 1994
  1. Bailey, Philip: Homeopathic Psychology: Personalities of the Major Constitutional Remedies. North Atlantic Books,U.S.,1996
  1. Barvalia, Praful: Autism Spectrum Disorder: Holistic Homeopathy
  1. Boericke, William: Pocket Manual of Homoeopathic Materia Medica and Repertory. B. Jain Publishers, New Delhi, 2002.
  1. Hahnemann, Samuel: Organon of Medicine. Orion Paperback, London, 2003
  1. Iyer, Malathy: IIT-B team shows how homeopathy works, TNN Dec 16, 2010, Times of India http://articles.timesofindia.indiatimes.com/2010-12-16/mumbai/28261112_1_iit-scientists-sweet-white-pills-work-homeopathy-paper
  1. Kent, James Tyler: Repertory of the Homoeopathic Materia Medica, ed. 6. B. Jain Publishers, New Delhi, 2004
  1. Lansky, Amy L: Impossible Cure: The Promise of Homeopathy. R.L. Ranch Press, California, 2003 www.impossiblecure.com
  1. Rajalakshmi, MA: Role of Homoeopathy in the Management of Autism: Study of Effects of Homoeopathic Treatment on the Autism Triad. The Internet Journal of Alternative Medicine. 2008. Volume 6 Number 1.
  1. Rajalakshmi, MA : New Dimensions in the Treatment of Autism with Homeopathy. The Internet Journal of Alternative Medicine. 2009 Volume 7 Number 2
  1. Rajalakshmi, MA: A Case of Autism: A Case for Homeopathy: Invited Article published in Homeopathic Links April 2011 issue, Thieme Publishers (Peer reviewed international journal published from Netherlands)
  1. Rao Manju Lata, Roy Rustum, Bell Iris R. and Hoover Richard: The defining role of structure (including epitaxy) in the plausibility of homeopathy, Science Direct. References and further reading may be available for this article. To view references and further reading you must purchase this article. http://www.sciencedirect.com/science/article/pii/S1475491607000628
  1. Rimland, Bernard, Edelson, Stephen M: Autism Treatment Evaluation Checklist. Autism Research Institute, San Diego, California, 1999: http://www.autism.com/ind_atec.asp
  1. Sehgal, Yogesh: Perfect Materia Medica of the Mind. B. Jain Publishers, New Delhi, 1998
  1. Vithoulkas, George: Science of Homeopathy, Chapter7, B Jain Publishers Pvt Ltd. New Delhi (India) 2002

About the author

M. A. Rajalakshmi

M. A. Rajalakshmi

Dr. M. A. Rajalakshmi is a registered homeopathic physician from Bangalore, India, practicing for over 15 years. She holds a BHMS and a Masters Degree in Counseling and Psychotherapy. She has a particular interest and experience in treating children with Autism and Neuro-Developmental Disorders, and has presented research papers on homeopathy and autism in national and international conferences, and published in peer-reviewed journals. An Interview with Dr. Rajalakshmi was published in the book, Homeopathy And Autism Spectrum Disorders: A Guide For Practitioners And Families (2014 Singing Dragon -Jessica Kingsley Publications.) She has served as faculty in the holistic therapy unit of a medical college hospital in Bangalore and very briefly as a lecturer in a homeopathic medical college. More recently she ran a homeopathic clinic in the Child Guidance Centre of a rural psychiatric hospital in Calcutta for a year, where she also helped conduct music therapy programs for residents with chronic mental disorders. She is currently self-employed and practices online. https://sites.google.com/site/anjanahomeocare/

2 Comments

  • Dear Dr Rajalakshmi,

    Just seen your article and really want to know whether you can treat the autistic case by online consultation because I am from Hong Kong with a 5 yrs old autistic son with pretty similar symthoms of your mentioned case no 3. Can you reply my personal email on your consultation way, procedures and fee?

    Regards, Alex

  • An important subject and exceptionally well written! I really liked that you included the case summaries to illustrate. I hope we will see more from you on Hoacuoidep.

Leave a Comment

Your email address will not be published. Required fields are marked *

дапоксетин инструкция цена

Вы можете https://steroid.in.ua у нашего менеджера.
mitsubishi l 200