Clinical Cases

Dissectional Study Of A Case

Darshan Jayesh Shah

Dr. Darshan Jayesh Shah does a dissectional study of a chronic case of migraine in a woman of 30.

Dissection means very a detailed analysis of a text or data. When we say dissection, the first thing coming to mind is the anatomical understanding of that particular cause. We will see how I try to dissect a case and come to a conclusion, for learning Aphorism 3 of the 6th edition of Organon of Medicine, that cure has to be rapid, gentle and permanent throughout a case.

CASE

Date of consultation – 10/01/2016

Name – Mrs. S.S.S.

Female, 30 years

C/C:

  • Migraine since 10 years, starts with blurriness and occasionally blindness, then pain in one side of the head, followed by nausea.

At least 4-5 attacks in a week.  Lasts an entire day.

Pain is unbearable++. Takes a pain killer.

Lachrymation with headache

Occurs on either side, not fixed to a particular location.

A/F- lack of food +, lack of sleep++

< winter+

< Emotional talks, fights, arguments with husband or family members.

Needs a good massage or hard pressure to relieve her.

  • Cold and cough,

Always, 365 days

Right nostril stuffed.

< humidity+

  • Lower back pain, post delivery.

? Due to Caesarean section.

< lifting weight

< wrong position

GENERAL REACTIONS-

Appetite– reduced

Craving– Sandwich++, Vada Pav++

Aversion – Roti, Sweets++, Chocolates

Thirst– 3 litres/ day,

Food/ drink- agg/amel– rice < stools

Sleep– sensitive, wakes up with smallest noise or light, and then not able to sleep.

Position- right side.

Dreams– as if she will fall down.

Stools– twice/day. Satisfactory evacuation.

Urine– NS

Perspiration– axillae, Nose tip

Leucorrhoea-  occ, once in six months.

Menses-

LMP- 24/12/2015

Regular, 4 days, dark red with clots, esp. on first 2 days. Comes every 28-32 days.

Before– Irritability +, lower back pain with tingling sensation.

During– NS

After– feels much better after the flow starts.

FMP- 13 yrs.

Obstetrics History-

G1 P1 A0 L1.

L1- 3 yrs, 9 months FT LSCS.

Weather- Cant tolerate summer, Slow fan, Hot water bathing, Covering due to habits.

MIND:

Her childhood was very playful. She has 2 brothers used to play outdoor games with them, etc.

Friendly, but has her own choices. Doesn’t like to be open with everybody; has selected number of people who she talks to.

Anxiety about daughter and her health, as she also has cold cough throughout the year, very worried, keeps on thinking about it, whether she’ll not develop any major disease like asthma or any other respiratory disease, etc

Doesn’t like arguments, avoids them. Hardly gets angry, but feels better after speaking up.

Indifferent towards anger now

Fastidious++, half of her day passes by in cleaning and arranging her house

Anxiety++, when time is set, for example – if she has to get to daughter’s school at 9am, her preparations start at 7 am for it.

When meeting anyone at a particular time, she calls up that person 10 times to confirm that she is on time.

Before starting new things, feels anxious, eg – when she started taking tuition classes, she was anxious whether she would be able to do it or not.

Irritable; when husband drinks alcohol or doesn’t take her out for movies, etc. Feels as if he is not giving her time.

Her marriage was arranged; got willingly married to the present husband. But during her pregnancy, got to know about past hidden affairs of husband, so she left the house, wondered why she married him. It was a wrong decision, etc. Can’t develop trust completely again.

Now, “Forget it” attitude about everything in life. My views towards people have changed, I have tried opening up. My relation with husband has also changed, after he convinced me of not having any extra marital affairs. Now I am happy in the relationship.”

Can’t stay alone, claustrophobic++, especially lifts and houses. Needs someone always, can’t stay alone at all, and would even call someone home to stay back at her place+.

Obstinate++, but if things don’t go her way, she would give up. It should be done the way she wants it. Always!

Creative things, like drawing and painting are her best friends. Wants to be active always+

Ambitious, planning to study Montessori (teaching kids) so as to get a qualified teaching degree.

P/H-

Jaundice – 12th std.

Chicken pox in childhood.

F/H-

Father- expired 15yrs ago.

Mother- back pain, osteoporosis, vertigo.

Aunty – CA Rectum

On observation –

Lean constitution+

CASE SOLVING –

The totality of the chronic headache shows a peculiar remedy coming up, which can be confirmed at physical generals and even at the level of mind.

TOTALITY OF THE CASE –

  1. MIND – ACTIVITY – desires activity – creative activity
  2. MIND – AILMENTS FROM – anger
  3. MIND – AMBITION – increased
  4. MIND – ANXIETY – time is set, if a
  5. MIND – FASTIDIOUS
  6. MIND – OBSTINATE
  7. HEAD – PAIN – chronic
  8. HEAD – PAIN – excitement – emotional; after
  9. HEAD – PAIN – fasting agg.
  10. HEAD – PAIN – pressure – hard – amel.
  11. HEAD – PAIN – winter headaches
  12. SLEEP – POSITION – side; on – right side; on
  13. GENERALS – COLD; TAKING A – tendency
  14. GENERALS – FASTING – agg.
  15. GENERALS – FOOD and DRINKS – bread – desire
  16. GENERALS – FOOD and DRINKS – spices – desire
  17. GENERALS – FOOD and DRINKS – sweets – aversion
  18. GENERALS – LEAN people
  19. GENERALS – MENSES – during – amel.

So, even after coming to a totality and a remedy, if the remedy is the simillimum it would have its sphere of action over the patient’s physicals as well as mental generals and particulars.

Just for a sectional study of the case, we will consider the patient in parts, and then confirm through repertorization that every section of the case would represent a single remedy when it is a well selected one, that is the simillimum.

Thus, what Dr. Boenninghausen states “what is true to a part is true to whole organism” can be studied through live cases, by retrospective study of solved cases of the masters and by using the principles of Organon for solving each case as an individual.

Quoting from Dr. Boenninghausen –

The lesser writings of C. von Boenninghausen – Brief directions for forming a complete image of a disease for the sake of homoeopathic treatment –

“ With respect to completeness in every case the exact location of the pain in the body (e. g., on the head: the forehead, the temples, the sides of the head, the vertex, the occiput; then also whether on the right or the left side, in the half or the whole of the head); so also the time and circumstances should be enumerated, which have an influence on the aggravation or amelioration of the pains. As to the time the exact times of the day (whether morning, forenoon, afternoon, evening, night, before midnight, after midnight) should be enumerated. So also the periodical aggravation of amelioration as to hours, days, or seasons should be exactly reported. Among the circumstances it should always be stated what influence is exerted by rest or by motion, and by particular modes of the same (e. g., lying, sitting, standing, walking, running, riding on horseback or in a vehicle, etc.), so also the influence exerted by warmth or cold, the open air and the room, by various enjoyments, by touch, by baring the body, by overheating, by eating and drinking in general, by emotions, by dry or wet weather, by thunderstorms, by daylight or candlelight, etc., as to the aggravation or amelioration of the symptoms.”

Thus, our case has the location, circumstance – emotions; excitement, periodical aggravation – season; winter, as to the aggravation or amelioration of the symptoms.

DISSECTIONAL STUDY –

PHYSICAL PARTICULAR TOTALITY –

PHYSICAL GENERAL TOTALITY –

MIND TOTALITY –

Considering each section and when combining each of them, we come to a group of remedies which come up at each level.

They are –

Lycopodium, Arg-nit, Calcarea carb, Phosphorus

ARGENTUM NITRICUM –

  1. In the book “Agitated Argentums” by Farokh Master, a similar picture mental picture is given in the case of renal failure.
  1. Also, the descriptions of head in the same is very similar to our case described by Farokh Master in his comparison of remedie in the book “Sandy Silicea” –

Argentum nitricum

Constitution – Nervous children with vivid imagination, Carbo-nitrogenoid

Physical make-up – Cachectic, scrawny, withered

Temperament – Bilious temperament very irritable and becomes angry easily

Thermal modality – Hot patient agg. cold (all symptoms except gastric symptoms)

Aversions – Sweets, Cheese

(Sandy Silicea – Dr. Farokh J. Master)

  1. Argentum nitricum – Head – the pain amel. tightly binding or pressing head and by cold air; at night, with heat and excitement;

(Handbook of Materia Medica and Homoeopathic Therapeutics – T. F. Allen)

  1. Argentum nitricum – When I began my experiment I was quite well and strong, but afterwards was sick, and my stomach suffered for many days after I had discontinued the use of the silver; I frequently had heartburn, from which I had never before suffered, though these symptoms gradually disappeared. But in their place there soon appeared an almost uninterrupted neuralgic pain in the left infra-orbital region, which for some moments became most terribly severe, and lasted with interruptions the whole following winter.

(Encyclopedia of Pure Materia Medica – T. F. Allen)

  1. Argentum nitricum – Towards the end of the winter the attacks diminished in intensity. (Encyclopedia of Pure Materia Medica – T. F. Allen)
  1. Argentum nitricum – In such mental exhaustion, headaches, nervous excitement and trembling, and organic troubles of the heart and liver in business men, in students, in brain workers, in those subject to long excitement, in actors who have kept up a long time the excitement of appearing well in public. (Lectures on Homoeopathic Materia Medica, 4th edition – J. T. Kent)
  1. Argentum nitricum – Headache from mental exertion, from excitement, with vertigo, nausea and vomiting. (Lectures on Homoeopathic Materia Medica, 4th edition – J. T. Kent)
  1. Argentum nitricum – Mind – Sometimes nerves go so unstrung that he was in a frenzy of excitement; when seized with these attacks did not desire to move or talk, but always sought a chair and stubbornly stuck to it.

(Guiding Symptoms of our Materia Medica – Constantine Hering)

About the author

Darshan Jayesh Shah

Darshan Jayesh Shah

He has completed his B.H.M.S from CMPH, Mumbai and has been a University topper in his 1st BHMS. He has been working in close association with Dr. Farokh Master since past more than 20 months. He is fascinated with and has a special interest in the in depth study of Hahnemann’s Organon of Medicine and Aphorisms and it’s practical application into practice. Practices at Guru Gobind Singh Homoeopathic Charitable clinic, under Dr. Farokh Master, 3rd road, Khar Gurudwara, Sri Guru Govind Singh Marg, Khar West, Mumbai – 400 052 on Mondays and Wednesdays 6:30pm to 8:30 pm since past 7 months. Contact – healing.with.homoeopathy@gmail.com

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