D: physicians questions
P: patients reply
Bracket with italics = comment by physician
A thirty four year female, consulted on 7 december 2013.
D: Tell me about your problem?
P: Lot of hair fall in general and there are small patches where hair has gone. I checked for thyroid but it is normal and also started getting greying of hair. I applied hair colour and since then the hair fall is increased and patchy hair loss started.
D: tell me more about the problem?
P: Hair has grown thinner and it does not look good. It is more during monsoon and when there is change of water.
(She tells about chief complaint and modalities that is Level 1- Name and Level 2- Fact. At this stage we want to go to deeper levels of emotion, delusion and sensation. It is done by asking the patient the effect of chief complaint. This takes us mostly to the emotional level and sometimes gives you the miasm also.)
D: How does it affect you?
P: I feel very irritable when I feel that I don’t look good. I am generally also very irritated when there is more work.
D: Tell me about your anger?
P: I get very angry even on slightest reasons. Even my child hits me with a light punch. I feel like hitting him back. I don’t hit my child, but I get very angry. I cannot tolerate it.
(We want to qualify more about this anger and find out what is the peculiarity about the emotion. )
D: Tell me more about your anger?
P: Whenever there is stress, I get very disturbed. Body becomes numb. I feel tingling and numbness on one side of the body. I become so wild that I don’t understand what I am talking about. Anger comes very fast. My head becomes numb. I get angry on slightest provocation.
D: What makes you angry?
(After having qualified the anger and noted the peculiarities, this question would lead us to how she perceives the situation where anger is an obvious reaction. This is the level of delusion- Level 4.)
P: This started after the misunderstanding with my husband. I had a suspicion that my husband had an affair with someone in his office. If this happened he would not give enough time to me or the children. Now if he tries to get close to us, I don’t like it and I get very irritated.
(Here she gives us a situation that has stressed her. How she experiences this situation will reveal to us the sensation level.)
D: Say a little more about misunderstanding.
P: Ours was a love marriage. Where I am a Maharashtrian and he is a Muslim. We married in spite of opposition from my parents. My husband used to work in a medical store and he would come very late. So I had lots of doubts about him that he has already having an affair with someone. There was a constant feeling that he is cheating on me. I knew it was not true but yet I kept feeling that way.
P: I felt that I should look more attractive and hence I would try to make all the attempts to look good.
( Now the patient is getting into the delusion level – which is the closest to the sensation level. One has to be very attentive at this stage since expressions at this level reveals the actual experience of the patient. At this level it is the experience that will give us the words indicative of the kingdom, subkingdom and the exact remedy required by the case. )
D: What was the experience of the anger? How did you feel to be in this situation?
P: It felt very suffocated and irritated. I was very angry. I felt how could he do this to me.
D: Describe suffocated?
P: As if something will happen….someone will come and harm me.
D: Say more about this experience?
P: I felt very vulnerable.
D: Describe vulnerable?
P: Not able to fight back.
( It is as if someone will do something to me; the other person is a problem. This is the hint to animal kingdom. Also there is a feeling of being suffocated and being vulnerable. Gradually a pattern is being built. This extreme sense of vulnerability and feeling suffocated amongst the animal remedies indicates the snake remedies. Snake remedies feel themselves at a disadvantage and being vulnerable from attack (1). Suffocation is also a major theme of the ophidia class of remedies. With this background in mind we explore other level 4 areas that can give us further understanding about the remedies amongst the ophidia class of remedies. Dreams are at level 4 so we go to the dreams )
D: What dreams do you get?
P: I get various types of dreams. As if somebody is there in my house.
P: As if somebody is around. Even as I am working I feel somebody standing behind me. I see dreams that somebody is killing someone. There is lot of blood. Feel very chilly when I wake up after such kind of dream. I have to cover myself and take God’s name.
D: What other dreams do you see?
P: Some faces of people I have seen in the day and I have a feeling in the dream that somebody just passed behind my back or as if someone is standing behind me.
D: What other dreams?
P: Very dirty dreams. That I never see myself in full clothes.
D: Tell me more?
P: Also sees that someone is holding me forcefully and trying to have physical relationship with me….Like a rape.
D: What is the feeling in this dream?
P: That this person will kill me, hold my neck and strangulate me.
D: What was the feeling?
P: Suffocated as if someone is holding your neck very tightly.
(So we have dreams of rape / nakedness / pursued …. when we see these dreams in context to the understanding already gathered, we get some more peculiarities. The level 4 and the sensation level is further qualified. Now we can explore other areas to confirm and to get more clarity about the remedy )
D: Tell me about your fears?
P: I have fears of all animals especially of cockroaches and earthworms. But the most I fear are snakes. Even if I see a snake on television, I would have a dream of snakes. It is not there much for other animal as it is for snakes.
(Many times there is fear or fascination of the source – the remedy the patient needs.)
D: Tell me about fear of snakes?
P: I love to see snakes and am very fascinated with them but equally fear them. Once in a dream a snake is sitting near my head while I am sleeping. Had a great fear that it will bite me anytime. I would get dream of snakes even before marriage.
D: What was the feeling?
P: Fear that it will come from behind me. I have not done any harm but it cannot be trusted. It may come from behind you and bite. This is the intense fear that it will attack you suddenly from nowhere.
End of the case.
Understanding of the Case
There are few peculiarities at the level of alopecia or hair loss and then she takes us to the emotional state and her stressful situation. The anger is violent and she wants to hit and shout. Also there are themes of attractiveness and suspicion about the husband having an affair. At this stage there are lot of remedies that can be thought of based on the information, like Hyoscyamus, Lachesis etc. But there are still symptoms and experiences that at a deeper level and we’ll see if they can help us to individualise the patient state with more accuracy.
There is a feeling of vulnerability and suffocation and also dreams of nakedness and of rape; of snakes. Also she has the constant feeling that someone is around her. We see that at the level of her subconscious, her delusion and sensation level, she experiences threat and suffocation. This is the experience of a snake remedy. Also, when we look in the repertories for the above features there are definite symptoms that are peculiar :
- Dreams naked
- Dreams of rape
- Delusion someone is behind him
- Dreams; snakes, of
We find the remedy coming up prominently is Cenchris contortrix.
Cenchris belongs to the crotanlinae family of the ophidian group. The main feeling of Crotalinae (1) is of a constantly perceived danger or threat from others or vice versa. Hence this makes them extremely agile and alert. They are very sensitive to the slightest changes in environment and have heightened senses and extrasensory perception – like a sixth sense, to be able to perceive danger and to attack suddenly and accurately.
Other remedies belonging to this family are : Lachesis, Crot. Horridus, Crot. Cascavalla
Prescription : Cenchris contortrix 1m – one dose
Follow up :
Treatment started on 7 December 2013
She had complains of hair fall and patchy hair loss.
Follow up on 24 December 2013
Her hair fall is better. Her irritability has increased. Sleep better and appetite is better.
Generals- better. Dreams only once
SL for 15 days
11 Jan 2014
Hair fall is better, alopecia is also getting better – patches getting smaller in size. Irritability lessened. General health is good.
SL for 15 days
22 Jan 2014
Alopecia getting much better and overall her generals are better
SL for 15 days
8 February 2014
Hair fall increased a bit. Generals are not better. Her anger and irritability increased.
Cenchris 1M single dose and SL for 15 days
5 March 2014
Her anger has diminished. She is feeling very less irritated. She started taking tuitions at home. She used to be very hyper in the evening and now she is not. Even her mother in law is shocked by this.
SL for 15 days
28 March 2014
Alopecia size reduced very much. Hair fall is also much better. Sleep-better, appetite better.
No dreams. Skin eruptions is also better. Irritability totally gone.
SL for 15 days.
Patient continues to be well. Stopped treatment as all her patches have healed. No new patches till date.
(1) Rajan Sankaran – Reptiles volume 2.
(2) Levels of experiences- from Sensation in Homoeopathy.
Hi..nice case..just a query..Is’nt the seat of action of a medicine important while considering it for a particular case?