A man aged 38 years old came to meet me at my clinic on 31st May 2008. He was slender, tall and fair.
His complaints were narrated as follows:
I have a problem of frequent sneezing, sometimes even 20-30 sneezes come on in a row. It has been there since my childhood and has gotten really severe in the past 3 weeks. There is no specific weather or season when it’s worse; it comes on at any time. I end up with a runny nose too. I also have a nose block occasionally, always on one-side with either the right or the left getting blocked.
I feel cold very easily and don’t tolerate cold weather well. I do not get any fever with the sneezing. I feel anxious for small things. My wife had an ovarian cyst surgery four years back after which my anxiety developed. I was really tensed; even now I feel very anxious about my wife’s health and have concerns about my health too. I also feel anxious at times when there is pressure at work. Small things like my doctor checking my blood pressure, makes me feel anxious. My heart starts to beat very fast when I feel so. I am also worried that my wife is finding it difficult to conceive, since we both want to have a child. Though my anxiety is not very severe, I do take Anxiolytics prescribed by my physician.
I am a manufacturing engineer, and I play an important role as I manage quality control. I am quite friendly with my employees and I have a good performance rating at work.
I had mild dizziness 3 years back. I also had a surgery for removal of piles in 1998.
Family History- Father- Allergic Rhinitis.
The following investigations were performed;
Body Temperature- 98 F
His reports which he brought along with him showed:
Lipid profile :
Total Cholesterol- 276 Triglycerides- 319 LDL- 176 HDL- 38
Absolute Eosinophilic Count (Allergy indicator) 600/mm3
Initial Assessment I noticed that this man was extremely soft spoken and very polite. I found that he was “mild” by nature and I took that as an important rubric for prescription. Hahnemann and Boenninghausen both refer to the importance of assessing the physical constitution, mental temperament and predisposition during case taking. His nervous nature stood out too, as he even had to be put on Anxiolytics to feel calm and composed. I could not base my prescription on mentals alone as his physical complaint of sneezing was deep rooted for he had the problem since his childhood days. I had to find a remedy which covers both his physical as well as his mental and emotional state equally well. A constitutional prescription would be the best choice here.
Repertorization using Roger van Zandvoort’s Complete Repertory
(Mind)Anxiety: Health, about
(Mind)Anxiety: Health, about: Relatives, of
(Mind)Anxiety: Business, about
(Chest)Palpitation heart: Anxiety, with
(Nose) Sneezing: Frequent
(Nose) Discharge: Watery
(Nose) Obstruction: One-sided
Based on the Repertorization, the following remedies were considered: Pulsatilla, Natrum Carb, and Phosphorus.
Pulsatilla– This remedy is suitable for mild, gentle, yielding disposition individuals; which this patient was. It covered all the symptoms in the above Repertorization except the symptom of “one-sided nasal obstruction”. It has intolerance to external heat, and a marked thirstlessness with all its complaints. This man was very chilly, and there was neither marked increase nor decrease in his thirst. Though mentioned in the Repertorization for sneezing with watery discharge, the characteristic type of discharge in Puls is more of a thick, yellow, green discharge, like that seen in rhinitis with superimposed bacterial infection. Also, Puls is more often suitable for mild women (though it is used in men too). Based on the above logic I decided I needed a remedy which was not just similar but the “Similimum” for this case.
Phosphorus– Physically, this patient did look a lot like Phos, which is adapted to tall, slender individuals with fair skin. Easily catches cold and is chilly. Filled with fears and anxiety. All these symptoms seemed similar to my patient, but on repertorization, Phos does not cover “Anxiety: Business about”. This symptom was quite prominent in the case. Also, Phosphorus has a sanguine temperament. They would be more friendly and open. My patient though mild, did not seem overtly friendly like a Phosphorus type. I kept Phosphorus as my “second choice” if the chosen remedy did not give the desired result.
Natrum Carbonicum– Nash mentions that Nat Carb is one of our best remedies for chronic catarrhal conditions of the nostrils. Nervous excitement and palpitations. Extremely chilly. On repertorization Nat Carb covered all the symptoms in the case except “Nose: Obstruction: One sided”. The nervousness and the mild nature of this individual matched that of this remedy. Nat Carb has anxiety about his health as well as the health of his loved ones. Based on the above evaluation, Natrum Carb was selected: Kent mentions that the 30th potency is low enough to begin with in any acute or chronic disease. I chose to start with the 30th and follow up the series if need be. My patient was given Natrum Carb 30, a single dose, for 3 days consecutively, starting May 31, 2008.
June 10, 2008 – “My sneezing has reduced by 50%. I have developed sweating of palms and soles in the past 4 days.” On enquiry, he revealed that he used to frequently have this symptom before. No significant change noted with his nervousness. Continues to take Anxiolytics.
My Assessment – The return of the old symptom showed that the remedy chosen was the right one and the symptoms were progressing in the direction of cure. The curative action of the remedy should be left alone. I did not make any prescription.
July 9, 2008 – Patient came back for a follow up after a month. He said, “The first time when I came to you, I felt a significant relief in my allergy symptoms. I got some relief, no doubt, but I still have the allergic sneezing, though lesser than it was when I first came to you. The sweating in my palms and soles don’t trouble me anymore, they lasted a few days and went away on their own.”
My Assessment – The patient made some progress with the medicine but does not seem to be improving any further. This calls for a repetition of the drug, preferably in the same potency. Our stalwart’s advise us to allow a drug in the potency given to do as much good as it can before scaling up to a higher potency. I repeated Natrum Carb 30, twice a day for 3 days.
Aug 2, 2008 – “My sneezing has come down further, nose blocks are much better too. I am able to sleep well at night and feel more energetic through the day. I am also able to focus on my work better as the sneezing is not troubling me as much as before. My anxiety has come down a bit, though it is still present.”
My Assessment – Patient again has begun to show further signs of improvement after the last prescription. Wait and watch.
Aug 19, 2008 – He visited me and had the following to say; “I have been stressed out at work since we had some deadlines to achieve. I had also been exposed to chilly weather at night, while returning home. I have been having severe bouts of sneezing for the past 2 days with runny nose and watery nasal discharge. Also a mild headache but no fever.”
My Assessment – Nat Carb 30 did some good work but now it was time to step up the potency to help him further. This time I prescribed Nat Carb 200, one dose a day to be taken for 3 days.
Oct 13, 2008 – He came back after almost 2 months. On enquiring about the sneezing he said; “I have never had relief of my complaints for so long a period. I feel light, and active through the day. Earlier I had to drag myself through the day as I would always end up feeling ill due to my sneezing. Now I feel like a different man. My anxiety levels have also come down. I spoke to my physician about reducing my Anxiolytic medications and he has now reduced my dosage by half. I feel there is no need to worry about anything, as The Almighty is always there to watch over us and protect us. The reason I am back here is to show you the reports of my lipid profile which I took during my physician visit last week”.
Lipid profile Total Cholesterol – 199 Triglycerides – 145 LDL – 132 HDL – 45
Absolute Eosinophilic Count – 380/mm3
My Assessment – Since the patient was doing so well, it meant the remedy was continuing to establish order in his system. Hence there was no need for any intervention.
Jan 2, 2009 – No problem as such. Mild irritation in the nose since a week. Came to me to pick up a “preventive”, just in case his sneezing again begins. Anxiety much less, but continues to take half the dosage of Anxiolytics.
My Assessment – The irritation in the nostril was an indication that it was now time to act again. The medicine did it’s good for the few months since prescription but the patient was now ready for his next dose. Nat Carb 200, twice a day for 3 days.
April 15, 2009 -“I was feeling well for the last two months but since 15 days my sneezing again began and I feel it’s increasing now. I have been sneezing for about 2-3 times a day each bout lasting about 5 minutes. Otherwise I am doing well, but I am concerned about the problem re-appearing.”
My Assessment – The health of my patient has improved overall. He has more energy through the day and his blood reports are tending towards normal. I prescribed Natrum Carb 1 M- One dose a day for 2 days.
I received an e-mail from him in late Aug, 2009. He wrote as follows: “I am doing extremely well, both in terms of my health as well as my family life. My wife gave birth to a baby girl a week back and we are both overjoyed. I have stopped taking the Anxiolytics. I have no problem with my sneezing either. I am grateful for the recovery I had. I shall stay in touch with you in case of any further need of medications. Thank you.” I have not heard from him since, so I would like to think that he continues to do well. It was fulfilling to see how a single medicine like Natrum Carb (baking soda), in its potentized form could go all the way deep into the organism and establish order.