Name: Mrs. M S Date: 16/11/12
Age/Sex– 40/F
Occupation: Housewife
Chief Compliant: Syphilitic Skin eruptions of whole body ++ spot-like with intense itching
and bleeding on scratching X 3yrs.
Generalized dryness of the skin since the chief complaint
Palms of the hand are rough to touch.
Chronic Sinusitis X 10-15 yrs.
No sense of smell & diminished sense of taste. She can’t make out if taste of food is good or bad.
Migraine since childhood which is aggravated by exertion and whenever she has to go somewhere in anticipation and from sleeplessness.
Right Sided sciatica pain in leg, standing >
History of Present Illness: It started in 4th or 5th month of 3nd pregnancy as an itchy patch on abdomen which increased in rest of the period of pregnancy. For this she got allopathic treatment and it got better after delivery of the child, but after a while it erupted again and she again took allopathic treatment for it and it increased thereafter. Presently it has spread to the whole body, mostly on the stretch marks on the body.
Past History: Nothing significant
Obstetrics History: G3 P2 A1 S0, Abortion- Elective 1st Preg- Female child, 2nd Preg- Female Child
Menstrual History: Regular every 28 days for 4-5 days, with slight pain on first 2 days with normal flow.
Pregnancy History: This time she was not at all prepared for the pregnancy and the child, but she conceived accidentally and it was an unwanted pregnancy, but after consultation with the doctor and husband she has to agree as it was late for abortion.
After that she always had in mind to have a boy, just because she earlier had a girl and she aborted 2nd pregnancy also as it was a female fetus. As the pregnancy progressed, she had dry itching on the abdomen around the navel and in 4th month of pregnancy the doctor somehow told her that it was a female child, after which she got really disturbed and worried as the previous delivery was a C-Section. This one again had to be a C- section, which further upset her.
These things occupied her mind for the rest of the pregnancy. Her dry itching got worse in eruptions and spread throughout the abdomen. The rest of the pregnancy was normal. Contrary to the doctor’s statement, she had premature labour pains and instead of c-section the delivery was normal, as the pains commenced in the proper manner.
Family History: Hypertension, Diabetes Mellitus Type-2
Physical Generals:
Built: Heavy
Thermals- Hot ++
Thirst- Decreased
Food and Drinks:
Desire: Sweets ++, desires earth and eats spices and condiments instead of mud.
Aversions: Nothing Particular
Appetite: Normal
Perspiration: Profuse +, More on face
Urine: Normal
Stool: Constipated
Speed: Fast Physically and Mentally
Side Affection: Right (Right sided sciatica)
Senses: Hearing: N
Smell: Diminished
Taste: Diminished
Vision: 6/6
Sleep: Decreased and restless, position on side
Mental Generals:
When I asked her “Tell me about your nature” she said, “I am an angry person”. The first reply is of foremost importance and basically is the key point around which generally everything revolves. On further questioning I got the following details about her nature:
She is a fastidious lady who always wanted to have things her own way, being fussy about things. She is a very sensitive person to an extent that what others are talking about her bothers her much and she would go to them and have the courage to address things to them and convince them about who she really is.
She says if anyone from her family members forgets her birthday she will never forgive them and even can resist talking to them for months. There is a strong desire for appreciation for what she cooks, how she looks, and she craves for it. She is an open, extroverted person and ninety percent of the talking was done by her. While case taking, she would go on telling about herself even without questioning. She would go into thoughts and planning and if there is any function at home or if she has to travel somewhere and about the packing, ticketing etc.
Fears: She has fears of closed spaces as she told me “I keep the door of my bathroom open while I take bath and I can’t be inside with door closed, I can’t enter in a small lift and usually take stairs instead of lift.” She also doesn’t feel comfortable in crowded places whch give her a feeling suffocation. She avoids going shopping on weekends to avoid crowds. She also has a fear of heights, can’t stand on the roof top of her house and never tried to look down from heights.
Case Analysis:
What we need to cure in this patient:
- Dominant Miasm which is Syco Syphilitic as the eruptions were all over the body with intense itching and appeared like raised wheals (Sycosis) and tendency to bleed (Syphilis)
- The disposition of the patient along with the cause of the change in the homeostasis.
Rubrics which I got to select from:
As the ailment started during pregnancy, I have to look there only for the cause. As Master Hahnemann in his organon has said that to derange the dynamic vital force the cause also has to be dynamic (which is the external stimulus to our dynamic psyche) in Aphorism No. 11 and 189, which will manifest itself later in the form of physical disease.
During pregnancy she continued to think about the sex of the baby and followed by thoughts of C-section. So, I have the rubric “Ailments from Anticipation” and this also got confirmed by the basic disposition i.e anticipatory as her migraine used to precipitate whenever she was in anticipation or planning about future events. (Migraine is sensitivity derived and sensitivity is the mother of miasm and is always psoric in nature, i.e which comes out of genes and disposition, here the sensitivity which triggers migraine is “Anticipation”.
The second rubric which can be considered from the above scenario is “Anxiety from Anticipation”. As guided by Master Hahnemann that when a miasm has bloomed there is no importance for the cause in his organon.
Next to this is the rubric “Fastidious” as it is present in the patient so strongly.
“Angry Disposition” and “Extrovert personality”. Sensitive person to an extent that what others are saying about her bothered her much’- It means we have to select a remedy whose need is “self respect” and can’t bear anyone pointing a finger at her.
Fear: “Fear of Narrow places”, “Claustrophobia”
From physical generals if “Sweets desire”
Miasmatic Analysis:
Chief complaint is of bleeding eruptions- Syphilitic
Diminished senses of taste and smell- Syphilitic
Generalised dryness of skin- Sycotic
Chronic Sinusitis- Sycotic
Sciatica pain- Sycotic
Migraine- Sycotic
Now, from above case taking and analysis we conclude that we need a medicine which should be Hot, Right Sided, Extrovert, Angry, Anticpatory, Sensitive, Fearful and whose need is self respect. The miasmatic dominance of the medicine should be Syco-syphilitic. I shall not consider side because there are only sycotic affections on the right side and sycotic pathology should not be considered for side selection.
Rubrics considered for repertorisation:
We need confirmed rubrics which should also cover the genetic disposition of the patient so as to cure her completely
Remedy Given is ARGENTUM NITRICUM 200 only one dose
and Placebo for one month on 16/11/12
And analysis after adding sycotic rubrics to confirm the remedy selection
Why Argentum nitricum is selected:
We came out with the following medicines after repertorisation:
Sil: Silica is an introvert and timid medicine, and silica is not an angry
Medicine. Secondly, Silica’s build would have to be fine, refined and with lax fibres.
Plb Met: The action of plumbum met is more on the blood vessels and neurological centres of the brain, especially Autonomic nervous system with tendency to slow down the functions of the body, but this patient is of fast speed and action, is more on ectoderm and mesoderm which rules out plumbum met.
Nat.Mur– Again natrum is an introvert person and timid from genetics so, this is also ruled out.
Medorr: In medorrhinum the anticipation is the same as present in this patient, but what is absent in med. is the great demand for self respect and the extroverted nature. And fastidiousness in med. is not out of genetics, but it is acquired and sycotic in nature.
Carc: Carcinosin is a very suppressed and yielding medicine, it is sensitive for respect but is not courageous enough to express his anger and secondly carcinosin is an introverted and reserved medicine.
Ars: Arsenic is a very anxious remedy with restlessness and its haughtiness makes this medicine less talkative and insecurity of arsenic makes this medicine selfish and non social and arsenic definitely does not have courage to go and declare about himself to others.
Argentum Nit: Is selected as in argentums there is always a demand for appreciation and being a metal it will always have a structural and heavy build with prominent facial bones; secondly courageousness of argentums in confronting opinions of others is always found because of positivity. Also, argentums are much sensitive to the opinion of others just because they can’t have a bad name and demand only appreciation and good opinions about them. This trait made me select Argentum for this lady.
Next step is follow up:
And follow up according to Hering’s law should be in the following manner:
- Bleeding should stop first- Syphlitic more destructive
- Senses should come back- Syphilitic Numbness
- Sciatica pains should progess to stitching pains rather than continuous pains- Sycotic to Psoric
- Along with it, eruptions should go from above downwards and towards extremities, hands first followed by feet. Eruptions on the trunk should go dorsoventrally- in the direction of nutritional gradients of our body.
First Follow up: On 22/12/12
Itching Decreased (Psoric)
New spots on extremities (Hering’s law)
Stool unsatisfactory
Sense of smell Improving (Syphilis going down)
Medicine Given: Placebo
Second Follow up: On 6/1/13
Sense of Taste has Improved (Syphilis going down)
No more bleeding from eruptions (Syphilis going down)
Eruptions clearing out from trunk (Hering’s law – centre to periphery)
Sciatic pain is now not continuous but stitching pains are there (Sycotic to psoric)
Medicine Given: Placebo
Third Follow up: On 9/2/13
No new eruptions
Itching decreased and cleared out from trunk completely
Now eruptions are only on hands and legs below knees
Stool better
Senses of smell and taste better, now can make out easily the ingredients of the food.
Desire to eat earth gone
Medicine Given: Placebo
Fourth Follow Up: On 20/2/13
Patient had acute cough and cold (Acute psoric manifestation chronicity of miasm is decreasing), but she had antibiotics.
Stomach upset, constipation increased.
With weakness and letharginess
Medicine Given: Argentum Nit 1M one dose only
Fifith Follow up: On 16/3/13
Better
Eruptions only on feet and cleared up from whole body
Stomach better
Senses normal
Slight Acidity (Irritation-Psoric)
Migraine gone
Perspiration Decreased
Medicine Given: Placebo
Unfortunately I only have one photograph of the patient after she got cured and the scars are fading away in this picture.
Sir,Your observation on physiology and pathology of skin and on symptoms is good.