Repertory exercise 4 - Case Solving Analysis

Transcription

1 Repertory exercise 4 - Case Solving Analysis Case No. 1. Melancholia On 10th January 1958, Mrs. R.F., aged 60 years, came for consultation, complaining of the following: Last three years, has very poor sleep. Shooting pains in chest on and off, agg. speaking. Lightning pains in body, anywhere. Heaviness of body. Anorexia; Desires alcohol; Thirstless. Constipation with hard stools. Dyspnoea on exertion and on ascending stairs. Very small soft warts all over the body, sometimes painful. Sweats when excited. Very nervous; any little thing frightens her. Very sensitive; easily offended; weeps easily. Gets easily hurt, contusions take long to clear up and pain for a long time. Almost all her troubles started after the death of her husband 3 years back. Always thinks of dead husband. Likes to be alone or only in company of her children. Feels she ought to be happy in every way but she is sad without reason.she becomes very irritable, flies into rage and abuses but regrets later. Prev. Hist.: N.A. D. Family History: N.A. D. Physical Exam.: Pt. looks emaciated. Wt. 96 lbs. B.P. : 155/90. Otherwise N.A. D. Answer. In analysing and evaluating the above case, the symptom that struck me as very strange was the fact that she herself felt that she had all the ingredients of happiness but was unhappy without reason; this was a mental symptom. The apparent exciting cause, viz. the shock at the death of her husband, was also considered valuable as it had set into motion the whole panorama of mental and physical changes. Her recent irritability, the peculiar physical concomitant of painful warts, the constitutional tendency for wounds to heal slowly, were all given due importance and the case was repertorized as follows in Kent's Repertory: Grief, Ailments from (p. 51) + Sadness (p. 75) + Abusive (p. 1) = Am-m, Anac., Caust., Con., Hyo., Lyc., Nit-ac, Nux-v, Ver. + Wounds, heal, slow to (p. 1422) = Caust., Con., Lyc., Nit-ac + Warts, painful (p. 1340) = Caust., Lyc., Nit-ac + Warts small (p. 1340) = Caust., Nit-ac Out of the two, the drug Caust. seemed to fit the case better, esp. considering her depressive, brooding and hopeless mood, and so she was given one dose of Causticum 1M on When she reported on , she was less sad and excitable; pain chest nil; pain in body less; sleep and constipation better.

2 Case no. 2 Emphysema Shri P.A. M., aged 86 years, came to me for consultation on 25th Dec with the following symptoms: He has got asthmatic dyspnoea and cough for the last 12 years. Cough is amel. lying on right side. Cough and dyspnoea agg. strong odours. Sometimes he gets involuntary stool or urine on coughing. Expectoration is thick and sticky. His skin is very dry. Answer The case was repertorized in Kent's Repertory as follows: Cough agg. lying. side (p. 797) + Expectoration, viscid (p. 820) = Alu., Am-m, Kali-c, Lyc., Merc., Phos., Plb., Sil., Spo., Stan. + Skin, rough (p. 130) = Alu., Merc., Phos., Plb. + Rectum, involuntary stool, coughing or sneezing on (p. 621) = Merc., Phos. + Urination, involuntary, cough, during (p. 659) = Phos. + Cough, odours, strong (p. 798) = Phos. Phos. also covered the symptom "old age" as given in Phatak's Repertory (p. 200). Phos. 6, 1dose every 3 days relieved him considerably. Case No. 3 Cervical spondylosis Mrs. R.P., aged 42, suffering from cervical spondylosis decided to take homoeopathic treatment because the collar she had been prescribed was giving her discomfort without giving much relief. I saw her on 3rd Aug Her history was as follows: While at Bangalore on , she had a sudden, excruciating pain in the right scapular region and shoulder at 2 a.m. She woke up from sleep due to pain. Since then the pain has been there almost constantly. The pain is agg. at 3 a.m. She invariably gets up with pain at that time. It is agg. before menses, sitting and lying on right side agg. using the hand, e.g. as in writing. Pain in shoulder joint is agg. hanging the hand down, amel. heat, rubbing, amel. pressure in nape and shoulder. Appetite, etc., normal, but milk causes flatulence. Menstrual cycle - 3/28, regular. Had bad throat and sinusitis last 6 years. This is agg. by cold foods. Irritable worrying type, faints with pain. Prev. Hist.: Had a serious shock two years back (owing to her suspicion of her husband's infidelity). Amoebic colitis eight years back. Pleurisy 25 years ago. Answer

3 Her case was studied as follows on Kent's and Phatak's Repertory. The peculiar time and other modalities of the pain were taken first. agg. At 3 a.m. (K.p. 1343) + Before menses (K.p. 1373) = Am-c, Bor., Calc., Chi., Con., Dul., Kali-c, Kali-n, Mag-m, Nux-v, Sep., Staph., Zn. + Lying on painful side, agg. (K.p. 1373) = Am-c, Calc., Chi., Kali-c, Kali-n, Nux-v, Sep., Staph. + Sitting, while, agg. (K.p. 1401) = Do. + Food, milk, agg. (K.p. 1363) = Calc., Chi., Kali-c, Nux-v, Sep. + Fingers, working with, agg. (Ph.p. 107) = Calc., Kali-c, Sep. + Rubbing, amel. (K.p. 1398) = Calc., Kali-c + Food, cold, agg. (K.p. 1362) = Calc., Kali-c Between the two, I preferred Kali-c because it has more typically the 3 a.m. aggravation. So, on 3rd Aug. 1962, she was given Kali-c 30, 12 doses to be taken twice daily till relief was obtained. On 17th Aug., she reported that the pain had reduced in intensity; she was able to let her hand down without pain. From then, once she was put on Sac-l and was advised to take Kali-c 200 as and when necessary. She discarded the collar but still had no pain. She had to take in all Kali-c 200, 3 doses and by Nov. 1962, she was completely well and so the treatment was stopped. Now she has been well for over nine years. Case No. 4 Koch's abdomen Miss. R.S., aged 23 years, turned up for consultation on 21st Oct with the following history: She gets pain in abdomen for last five years. It is agg. rich, fat food, agg. lying on left side or back agg. summer amel. knee chest position. Gets dysponoea on exertion; desires deep breath. She gets a ball-like sensation moving in the abdomen from epigastric region to lower abdomen. Ring-worm on right elbow for last two months. Gets dreams of snakes. Prev. Hist.: She had disappointment in love and since then she is not well. Past H/o:- Malaria suppressed by quinine. It had been diagnosed as a case of Koch's abdomen. Answer He case was repertorized in Kent's Repertory as follows: The causation and the concomitant were taken first. Love, ailments, from disappointed (p. 63) + Respiration, deep, desire to breathe (p. 766) = Aur., Calc-p, Caust., Ign., Kali-c, Lach., Nux-m, Sep. The aggravation from a food item came next. + Food, fat, agg. (p. 1363) = Caust., Kali-c, Sep. The background of suppressed malaria came next.

4 + Quinine, abuse of (p. 1397) = Sep. A peculiar particular was taken last. + Abdomen, ball, rolling in = Sep. Sepia 1M gave her profound relief but the remedy had to be repeated in 1M, 10M, 50M and CM potencies as and when necessary till she was completely cured by Aug Case No. 5 Haemorrhoids Mr. K.V. R., aged 46 years, came for consultation on 27th July 1963, with the following history: He has piles for last 6 years with pain and bleeding. Gets burning pain for 2 hours after stool. Occasional occipital headaches amel. pressure, agg. summer, agg. in sun agg. reading. He is slightly worried because his daughters-in-law are not cordial. He has severe constipation. First part of stool is hard, then it is soft. He has to strain hard even for soft stool. He gets pain in abdomen from morning to noon, with a feeling of tiredness and pain in joints for last 6 years. Pain starts when straining for stool amel. after stool, slightly amel. moving. No appetite. Thirst, etc., normal. Sleep: He cannot sleep on back. Gets body ache in the morning. Prev. Hist.: 20 years back he had Double Pneumonia which lasted 3 months. Occasional dysentery. The case was repertorized in Kent's Repertory as follows: The peculiar stool and the modality came first. Stool, Hard, first, then soft (p. 638) + Rectum, Pain, burning, stool, after (p. 626) = Alumn., Berb., Caust. + Rectum, haemorrhage from anus (p. 619) = Alumn., Berb. The peculiar constipation was then taken. + Constipation, difficult stool (p. 607) = Alumn., Berb. The concomitant symptom was added. + Head pain occiput (p. 161) = Alumn., Berb. + Head, pain, pressure external, amel. (p. 164) = Alumn. Alumen 1M, 3 doses were given in one day : Patient gets bleeding + burning pain amel. itching + abdominal pain amel. Stool amel. Placebo given.

5 As he was gradually feeling better and better, placebo was continued for about one month. The doses of Alumen had to be repeated in 1M potency on , , and in 10M potency on He improved considerably after each dose and became well. Case No. 6 Menopausal syndrome Mrs. K.P., aged 50 years, was brought to me for consultation on 30th April She had got swelling all over the body. It had started after menopause. Gets dyspnoea on exertion, e.g. on ascending; headache agg. noise. Stiffness of back on waking. Sun agg.. Gets burning in chest, throat, etc., with headache at night waking her from sleep. Cannot bear hunger or fast. Feels agg. by talking. Feels something like a ball moving in abdomen. Wt. 188 lbs. The fact that her troubles had started after menopause, the origin was considered most important and was taken first. Then the general aggravation from sun was taken. Her case was repertorized in Kent's Repertory as follows: Menopause (p. 724) + Sun, from exposure to (p. 1404) = Agar., Bar-c, Bry., Calc., Gels., Glo., Graph., Ign., Lach., Pso., Puls., Sele., Sulph. Her excessive weight was taken next. + Obesity (p. 1376) = Agar., Bar-c, Bry., Calc., Graph., Lach., Puls., Sulph. Her inability to fast was taken next. Then two particular peculiar symptoms were taken, viz. the headaches coming on from noise and the felling of a ball rolling in the abdomen. Head, pain, noise, from (p. 144) = Bar-c, Calc., Graph., Lach. + Abdomen, ball, rolling in (p. 541) = Lach. Lach. also covered the headaches coming on in sleep and the burning pains. Lach. 1M, 3 doses in one day followed by placebo given : Condition better. Swelling amel.. Medicine repeated. She continued to improve and had to be given Lach. 1M, 10M, 50M and CM potencies as and when necessary, with a few doses of Rhus-t 6 on and off for minor rheumatic pains. Later on she received Lach. VI (i.e. 6th potency of the 50 millesimal scale) and by she had improved considerably and was practically normal.

6 Case No. 7 Pneumonia A few nights ago, I was suddenly called to see a patient who was said to be seriously ill in a town about 200 km away. I left the next morning and reached the town at about 2 p.m. The patient was an old lady, Mrs. S.N. M., about 64 years, who was suffering from Pneumonia for the last 13 days. She had been paralysed and had been in bed for one and a half years and possibly she had developed hypostatic pneumonia. She had been under the treatment of a homoeopathic physician who had prescribed for her well, but her condition had taken a serious turn and the homoeopath had become rather anxious. Therefore, he had suggested allopathic treatment and an allopathic doctor had been called in. This gentleman, however refused to come and attend to the patient. No doubt he thought that the homoeopaths treat patients till they become very serious or moribund and then call in the allopathic doctor to take the blame. This particular family had been having faith in homoeopathic medicine for the last 35 years. So they were still very keen to have homoeopathic treatment. Therefore, it was decided that some other homoeopath should be called in and I was selected. So the case was before me now. I examined the patient carefully and I found she had all the signs of Pneumonia. But there was no temperature, which was due to the very weak condition of the patient. The patient was fortunately conscious but could not speak as she was paralysed. I noted the following symptoms of the patient: she would suddenly laugh without any reason; she even laughed at me. Secondly, she would try to remove her blouse. Even if she did not take off her clothing, if her body was exposed for examination, she did not seem to mind it. She had plenty of thirst which was more marked at night. She had rattling respiration with cough agg. lying on the left side. The pupils were small and reacting to light. Her husband mentioned that she had become worse after she had taken a cold bath at the time she possibly had a mild fever. Now, I studied the case with these symptoms and repertorized her case as follows in Kent's Repertory and Phataks' Repertory. Shameless, exposes the person (K.p. 79) + Laughing (K.p. 61) = Hyo., Phos., Sec-c, Tarn. + Thirst for large quantities (K.p. 529) = Phos. + Thirst, night (K.p. 528) = Phos. + Cough agg. lying on left side (K.p. 797) = Phos. + Chilled when heated (Ph.p. 43) = Phos.

7 I found that the only remedy that came through was Phosphorus. I did not know if Phosphorus could be used in such a serious state. However, we gave her Phos. 200, 1 dose about 2 p.m. and after this there was a rise of temperature. I considered this a good sign because rise of temperature shows a re-establishment of resistance in the patient. I then advised them to continue the Phos., 3 times a day and then left for Bombay. Two days later I was informed that she was feeling better and after another four days I was told that she was completely well. We were then able to start the treatment for the chronic paralytic condition. I am describing this case only to show how even very serious cases can be treated with homoeopathic medicines very nicely and easily, even when the allopathic doctors may consider these cases beyond the scope of their medicines. Case No. 8 Hypothyroidism Mr. F.S. male, married, 32 years, tall, slender rather light complexion, looks older than his age. Silent, repressed, hard to get into conversation, takes long to feel acquainted with him. Restless, active, cannot be still, though appears to casual acquaintance slow, aloof. Lack of vital heat marked; woolen socks in summer. Faintness easily; has fainted many times, agg. getting up from bed, sight of blood, any ordeal. Hands shake when excited. Desires open air but agg. drafts. Sleepiness very marked; can sleep any time, e.g. sitting in chair. Thinks slowly; slow in reaching decisions. Appetite good; desires sweet things. Sleep restless; grinding teeth; many dreams. Sneezing spells in A.M. may last until noon. Tendency to vertigo. Numbness feet if sits with legs crossed. Amoeba found in stools in 1934, not since then. Laughing loudly at something read to him which was really serious. Queer dreams and thoughts; cannot describe them. The case is worked out as follows on Kent's Repertory. The peculiar mental symptom of laughing loudly at a serious matter was taken first. Laughing, serious matters, over (p. 62) = Anac., Ap., Arg-n, Can-i, Cast-eq, Ign., Lil-t, Lyc., Natm, Nux-m, Plat., Sulph. This was combined with another mental symptom, viz. Slowness. + Slowness (p. 81) = Anac., Ign., Nux-m Now a general symptom was taken, viz. the tendency to faint from excitement. + Faintness, excitement on (p. 1360) = Ign., Nux-m

8 Without further repertorization, considering the sleepiness and chilliness of the patient, it is evident that Nux-m is the correct remedy because it covers most of the remaining symptoms. Just for curiosity we looked into the repertory and found Nux-m under the following rubrics also, viz., "Talk, indisposed to" (p. 86); "Restlessness" (p. 72); "Heat, vital, lack of (p. 1366); "Air, draft agg." (p. 1344); "Sleep, restless" (p. 1247), etc. Dr. Green reported that Nux-m 10M was administered and produced a prolonged and very satisfactory improvement. Case No. 9 Headache Mr. J.S., aged 35 years, is suffering from headache since The headaches are almost constant. It was diagnosed as sinusitis and he was operated upon but with no relief. The headaches are better if there is a nasal discharge i.e. coryza. They are always right-sided and they are worse in summer. He feels better with Cafergot. He feels chilly with headache but also has much perspiration then. Headaches are worse on alternate days and on lying on affected side. They start in the right shoulder region and extend to the nape and he feels as if a nail is driven in, amel. by pressure. He has a previous history of fever suspected as malaria and a history of epistaxis in summer. Answer I repertorized his symptoms with the following rubrics in Kent's Repertory and Phatak's Repertory: 1. Chill with pain (K.p. 1269) 2. Perspiration during headache (K.p. 1297) 3. Head, pain coryza suppressed, from having a (K.p. 138) 4. Summer agg. (K.p. 1404) 5. Lying on painful side agg. (K.p. 1373) 6. Alternating effects (Ph.p. 8). I came to two remedies, viz. Lyc. and Puls. Because he was mild by nature, I gave him Puls. 200, 3 times a day.

9 He had an agg. for 2 days and from the 3rd day the headaches disappeared completely. He told me that in the last 16 years he had never been free from headaches like this and was most grateful to Homoeopathy. He remains free of pain now for over six months without any medicine. Case No. 10 Gangrene Mr. J.V. D., aged 62 years, came on for treatment of gangrene of the toes of the left leg from which he has been suffering since He had been advised amputation which he had refused. History and symptoms: In 1970 one toe was crushed and had suppurated. It was operated upon twice but did not heal and then gangrene had set in. Later, two more toes were affected; then it was diagnosed as chronic vascular insufficiency due to atherosclerosis. He had pain in the leg agg. 10 to 11 p.m., amel. pressure, agg. letting the leg hang down, agg. walking, agg. cold water application, agg. in sleep, even during afternoon sleep. He had a suicidal disposition. Head heavy with vertigo and nausea sometimes. He also had twitching on rt. side of the face and rt. side of the tongue with black patches on it. Lips black. Pain in soles at night, wakes up 4-5 times due to pain. Cannot wait for food. Loquacious. Prev. Hist.: Malaria in childhood. Used to smoke 50 cigarettes a day for 45 years. High B.P. since Now B.P. 200/130. The affected toes are black and gangrenous with a very offensive discharge. I took the following rubrics in Kent's and Phatak's Repertory viz. - Tobacco; agg. - Injury; gangrene; - Suicidal; - Agg. In sleep; - Rt. Side; - Black. China alone came through.

10 He was given China. 30 and he started improving. With repeated doses of China. 200, he became well. His B.P. became normal. The gangrenous toes healed. We stopped the treatment on Case No. 11 Lumbago Mrs. M., wife of the a doctor, aged 68 years, consulted me on 8th June 1972 with the following complaints: She is suffering from lumbago for the last 20 years. Now, cannot get up from bed due to the stiffness. Pain is agg. rising from sitting, agg. sitting long, agg. lying on back, agg. cold drinks, agg. stooping, cannot squat. It is amel. pressure and amel. massage. Gets pain and heaviness in thighs. She has become very obese. Her appetite, thirst, etc., are normal. She is amel. by company. Very irritable. Past. Hist.: She had thyrotoxicosis which was amel. with Neomercazol. Was operated for prolapse of uterus one year back. Fam. Hist.: Her sister had tuberculosis. The case was repertorized in Kent's Repertory as follows: Back pain, lying back, on (p. 896) + Back, pain, lumbar region, lying back on (p. 906) + Back, pain, rising from sitting (p. 897) + Back, pain, lumbar region rising from a seat (p. 907)]= Am-m, An., Ap., Berb., Bry., Carb., Lyc., Nat-m, Puls., Rhus-t, Sep., Staph., Tell., Zn. + Obesity (p. 1376) = Am-m, Bry., Lyc., Puls., Sep. + Prolapsus, uterus (p. 743) = Am-m, Bry., Lyc., Puls., Sep. + Cold drinks, agg. (p. 1363) = Lyc., Puls. I preferred Lyc. because she was rather irritable. Lyc. 200, 3 doses in one day : Feels 25% amel. but still has pain. Lyc. 200, 7 doses, daily once given : Felt amel. Lyc. 200, 3 doses in one day, to be taken weekly : Condition relapsing. Lyc. 1M, 1 dose was given : Condition normal. Lyc. 1M to be taken once a month, if necessary.