The subject is a 46 year old man with chief complaint of continuous swelling and pain in left side of abdomen since 4-5 years. It is a constant complaint day and night and the patient never felt complete relief for a day or for an hour in the last 4-5 years. This patient is a diagnosed case of ulcerative colitis and is receiving steroids and other allopathic medicines for it. This person presents with a lot of prostration, exhausted speech. His face is very oily; nose is swollen and red with pimple like pustular eruptions on it. He is married and has five children.
His case as given on July 18, 2002
“I have always suffered from acidity and stomach pain since my childhood. When I was 11 years old kid, I used to get severe pain in my tummy but my mother didn’t look after it. Later after age of 30, I suffered from acidity and gases daily for more than 10 years. I used to have sour eructation and daily vomiting, and fullness in my tummy with temporary relief with antacids. Later, I received natural medicines for several days and it got better but symptoms still remain”
“But last 4-5 years I am having this constant pain in abdomen. The pain is severe on left side of umbilicus. There is swelling starting from same point extending upward. The pain and swelling is continuous for day and night but is more severe after eating. I guess the pressure from food aggravates the pain as it gets worse within 10 minutes after eating food. The pain is more in the evening, on exertion. Any mental or emotional stress, disputes among family members aggravates the pain further. I can’t tolerate spicy food, hot food and certain fruits like mangoes and milk. It causes severe burning pain and heat in my tummy. I feel better when on empty stomach and on resting. I feel better after lying on left side”
“I am also having blood in stools daily since one month. Previously, I used to pass mucus with stools every day for few years. Mucus with stools is now occasional but was there daily 2 months back. Now I am passing about half cup of blood along with stools daily. I have been always constipated. Stools are hard, painful and I have to strain a lot to pass stools. I have to take higher dose of laxatives daily. I am receiving all medicines daily as prescribed by the doctor. I have been receiving 60 mg. of steroids daily along with other medicines for ulcerative colitis. Still the disease is getting worse day by day. Though frequency of stools has reduced from 4per day to twice daily, the amount of bleeding has increased. My doctor says the only option left now is surgery. ”
“I feel exhausted, weak due to this constant pain and swelling. Since I have started getting blood in stools, the weakness has got worse. I am unable to work continuously even for 10-15 minutes. I have no strength to talk with anyone. I just want to lie down and rest.”
“My appetite as well as thirst has gone down completely since last 2-3 months. I don’t feel hungry at all. Very little food fills up my tummy. I hardly drink a glass of water in a whole day. I like warm food but it aggravates. So I prefer cold things. I have a sweet tooth since childhood. Also, I eat less salt compared to my family members. I have a kind of aversion to salt since childhood. My urine is dark yellow since my water intake is very much less. I feel a lot of heat in my body but I sweat very little. My sleep gets disturbed around 2.30-3am and I can’t fall asleep again. The reasons behind sleeplessness are worries about family members, anxiety about my own health, financial tensions. Due to one reason or the other, my sleep is disturbed almost since 15years. 4-5 years back, I used to have repeated dreams of dead bodies, of cobra snakes. Recently there is no specific pattern in my dreams.”
“I can tolerate cold weather. If I go out in sun, I definitely get headache. Also, I am having these pimples on my nose constantly since 3-4 years. Swelling of nose increases further with heat in tummy and when I have constipation.”
“I am suffering since my childhood. My mother did lot of injustice to me. She never loved me but loved only to my younger brother. As a child, I was little mischievous. I never liked going to school. My mom used to tie my both hands and beat me on my tummy. She used to keep me hungry and ask me to work like a bull. Sometimes our neighbors used to give me food to eat. Many times she has beaten me on my tummy and now I have developed this ulcer. She always wanted me to die.”
“I never back answered to my mom. I always tolerated her unjust, unfair behavior towards me. I still visit her; help her financially.”
“The only person who loved me was my father. He used to take care of me, admire me. Many times he used to stay away from our village for his work. Those days, I used to feel like an orphan.”
“My father was actually my stepfather. I don’t know anything about my biological father. In fact I was never told anything about my biological father. Villagers used to taunt me for this. My friends used to tease me for being unaware of my biological father. I used to feel very bad but couldn’t say anything.”
“Since Doctor told me about my illness, my worries and tensions have increased further. My working capacity has reduced considerably. If I don’t earn who will take care of my family? I am the only earning person in my family. I am going through lots of financial troubles already. Still have to pay previously taken financial loans. How my family will survive if I die? I am telling my wife that she can leave me and marry someone else and live happily. I don’t want her to be alone after my death. I love her a lot. She is the one and all for me. She should always be happy.” (Patient got tearful while narrating this and started weeping)
At this time, patient’s wife who was attending him interrupted and gave further details as follows:
“He is a very simple person; very sensitive and mild. He takes everything on heart and suffers himself. He weeps even while watching an emotional scene on television or while listening to a sad song. He cannot fight with anyone. He cannot back answer to anybody. If our eldest son blames him for anything, he cannot back answer to him. He avoids quarreling, fights. He weeps easily. He has been crying all his life. He weeps with memories of his childhood, his suffering. He remembers his father and weeps……”
“…..He is a reserved and introverted person. He does not have many friends. He is emotionally attached to me. I am the only person with whom he shares his grief, worries. These days he worries a lot about our family. He broods over financial tensions and also about his illness. He has lost all hopes since he got to know about this serious illness. He tells me often that he is not going to get better and so I should take care of kids and myself. He feels sad thinking of my sufferings after his death and tells me to marry again and live happily.”
Since his childhood the patient has suffered from one or the other GI related complaints like abdominal pain, hyperacidity, constipation. His history shows that his complaints were under control with medicines. But 4 years back, the disease symptoms suddenly changed its presentation. In addition to constipation, now he has mucus and blood with stools. Now even after taking high doses of laxatives daily, the constipation is not improving. Previously he used to have occasional pain in abdomen. Now he has constant pain and swelling in abdomen, indicating some serious abdominal pathology. We can say that the defense mechanism of his body changed its gear 4 years back presenting itself through syphilitic manifestations which were psoric and sycotic before. So understanding the cause behind this is essential.
When he was asked about it, he became tearful and said, “My father passed away in 1999. His death was a major emotional trauma for me. I fell down unconscious when I heard about his death. I felt devastated. For many months I used to cry holding his photograph. He loved me, cared me. Since my childhood, he was the only one close to my heart. My symptoms started deteriorating day by day after my father left me.”
Past medical and family medical history: This person had pulmonary tuberculosis (right lung) 15 years back. He had renal stones about a year back. He got operated on for piles a year back. He gives a long history of hyperacidity and indigestion for 15 years, until he was diagnosed having ulcerative colitis.
There was no family history for ulcerative colitis or any major gastro-intestinal illness. Patient’s mother and younger brother were suffering from Thyroid disease. His father died of heart attack.
Swelling (Area of constant swelling is shown with dark line)
Maximum tenderness is felt in this region
Patient’s weight: 71and ½ kg.
Blood pressure: 120/80mm Hg.
This man has come for the relief of ulcerative colitis. His investigation reports confirm the diagnosis. Constant pain and swelling in left side of abdomen, blood in stools, severe prostration, despair and hopelessness are the presenting symptoms on the physical and mental levels. All these symptoms point toward the syphilitic miasm in the background. He has suffered from gastrointestinal complaints for many years. By nature, he is a timid, mild, sensitive, emotional and introverted person who has suffered from grief since his childhood. He feels deprived of love from his mother, lonely and like an orphan. Childhood sufferings are still alive in his mind. So sensitivity to grief and prolonged grief are definitely important while selecting the remedy. But grief due to death of his father was a major emotional trauma leading to the current pathology. His father’s death not only affected him emotionally but also his disease symptoms changed in presentation and got more serious. Since childhood the patient was emotionally attached only to his father. He also talks about the intense emotional and sentimental relationship with his wife now. This aspect of patient’s nature must be given importance while selecting the remedy: ‘Need and dependency on one relationship’.
Repertorization using Complete Repertory:
- Mind: Despair
- Mind: Hopelessness
- Mind: Ailments from: death: parents or friends of
- Mind: Grief, prolonged
- Stool: bloody
- Generalities: Weakness, enervation, exhaustion, prostration, infirmity: lying: amel
Natrum mur is the only remedy that covers all the symptoms. Natrum mur is indicated for all prominent features presented by the patient like prolonged grief, sensitivity to grief, mildness, sentimental, weeping, reserved, introverted nature and one to one relationships. It also covers other physical general symptoms like aversion to salt, headaches from exposure to sun.
Arsenicum album was another remedy considered after the repertorization but ruled out later on because the core indications of Arsenicum like restlessness, insecurity are absent in the present case. Prolonged and constant grief is affecting this patient and not anxiety or insecurity. Also, Arsenicum patient feels better after having warm food and warm drinks. But warm food or drinks aggravate pain in this patient.
Based on my evaluation and confirmation from materia medica Natrum muriaticum was selected. He took a single dose of Natrum mur 200c on July 18, 2002.
Follow up August 1, 2002.
He reports: “I started feeling energetic soon after taking the medicine. I had bloody stools for three days (July 22- July 24) and I felt quantity was little more. But there is no bleeding with stools since then. Stools are soft and I empty bowels twice daily. I noticed hard stools only twice and that was after eating rice. Since my constipation is much better now, I have stopped taking laxatives. I feel hungry but still eating less quantity because I feel pressure and pain in abdomen after eating. I feel thirsty. I drink about 3-4 glasses of water every day. One week after receiving the medicine, the pain in abdomen started reducing. Swelling also has reduced considerably. Now I can feel swelling only at one spot near belly button. Swelling and pimples on nose have reduced. Also, I am sleeping better. Now I get sound sleep for 4-5 hours every night. Due to this overall improvement I am feeling better emotionally.”
On examination, tenderness and swelling was felt only at one spot, on left side of umbilicus.
My assessment based on this information was that Natrum mur was acting. He was not passing blood along with stools. The constipation improved, stools are soft so that he stopped taking laxatives. Pain and swelling in the abdomen reduced to a considerable degree. The patient was feeling better physically and mentally along with improvement in appetite, thirst, sleep and energy level. So no action was taken as action of the remedy was still in progress. Follow up was scheduled.
Follow up August 26, 2002.
He reports: “I have good news. Last week I went to see my G.I. surgeon. They did Procto-sigmoidoscopy to check the status of ulcer (it was done on August 20, 2002) and results are much better. In my previous report (July 10, 2002) showed ulcerative colitis with moderate activity all over sigmoid colon. But doctor said, now the ulcer is looking like non specific colitis though the size of the ulcer is still same. Doctor advised me to reduce steroids by 45mg. Now I am receiving only 15 mg. of steroids per day. He also advised to stop one other drug that I was receiving for ulcerative colitis. I am feeling much better now. My stamina to work has improved a lot. Now I can work continuously for 3-4 hours. My appetite and thirst has improved further. Now I can eat good quantity of food with no complaints. I drink 6-7 glasses of water per day. My bowel movements are regular. I empty bowels once or twice daily. No bleeding or mucus with stools. Stools are soft. I haven’t taken laxatives since more than a month now. I had cough with white expectoration for 3- days. But it got better on its own.”
In response to questioning he said, “Mentally I am feeling much better. Depression is much less. I still worry about my health but now I am confident that I am going to get better.”
My assessment: He was continuing to improve and now the improvement is evident on the pathological level as well. Improvement in stamina and capacity to work is remarkable. At the beginning of the treatment he was unable to work for 15-20 minutes and now he is able to work for 3-4 hours. His appetite and thirst have improved further with no complaints even after eating a good amount of food. Mentally, he does not feel hopeless or in despair now. This is a good sign indicating he is coming out of the syphilitic miasm. His pathology report correlates with this inference. The previous report diagnosed ulcerative colitis with moderate activity but in the current pathological report, the ulcer is less severe and relates with non specific colitis. He still has anxiety about his health but at the same time he is positive about the recovery. Getting cough with white expectoration was considered a positive symptom indicating the forward momentum of the process of cure. With the reference to the book ‘The Science of Homeopathy’ by George Vithoulkas, the disease force was moving from more important organ (colon) to less important organ (upper respiratory track) and from more serious miasm (syphilis) to less severe miasm(psora). So no action was taken and follow up was scheduled.
Follow up October 10, 2002:
Patient reports: “All previous symptoms related to ulcerative colitis are much better. I don’t pass blood or mucus with stools. I don’t have pain or swelling in abdomen. As I am not having any complaints, my doctor suggested me to stop taking steroids completely. Now I am receiving only one type of medicine per day. Doctor said if I continue to improve the same way then I will be able to stop that as well. My appetite, thirst, energy level is good. I am able to work for 6-7 hours without any complaints. I pass stools once or twice daily and stools are well formed. I don’t have any complaints with bowel habits. I had gas with fullness in abdomen couple of times last week but it got better with slight modification in diet. Few new complaints have started 8-10 days back. I had dry cough couple of weeks back but it got better on its own. The cough used to be worse on lying down and in the evening. Drinking warm water used to give me relief. The cough got better and now I am having nasal discharge. It is white, sometimes thick but mostly watery. There is no fever. I am also getting these eruptions and itching on face and on back.”
In response to questioning he said, “I have no fever. My energy level is good. I am working daily for 7 hours. These complaints are not affecting my work. Mentally I am feeling good. I don’t feel depressed as before. In fact I am more energetic and positive than ever before.”
My assessment: The patient is continuing to improve further. The disease force is moving further to lesser important organs. Dry cough, watery coryza and skin itching with eruptions are all symptoms of psora. So we can say that the disease is now manifesting itself in psoric form. Getting eruptions on face and back is nothing but the exteriorization of the disease force on the level of the skin. No action was taken and follow up was scheduled.
Follow up November 5, 2002:
He reports, “Yesterday, I had another Procto-sigmoidoscopy to check the status of ulcer. And results are absolutely normal. The colon mucosa is absolutely normal. Doctor said my ulcer has healed completely. He advised me to stop all medicines.”
In response to questioning he said, “Symptomatically also, I am doing much better. I have no complaints with appetite, thirst, bowels habits or sleep. I don’t feel tensed or depressed as before. Since my health has improved, now I don’t worry about money matters. I feel confident to take care of it. Occasionally, I get acidity or gas. Generally I get these symptoms after eating very spicy food or green chilies etc. It gets better in a day or two with correction in diet. After, my last follow up with you, I got eruptions almost all over my body. Itching was less on legs but my chest, back, tummy, thighs were full of rash. I did not apply anything on my skin. Gradually itching and eruptions are getting less. I can still see few eruptions on my thighs and legs.”
My assessment: The process of exteriorization of disease in the form of psoric skin eruptions is still continuous. At the same time, sigmoidoscopy results show that the ulcer (syphilis) has healed completely and colon mucosa is normal. Healing of ulcer and skin eruptions at the same time indicate Herings law of cure coming in action. Since patient was doing well physically and mentally, no action was taken and follow up was scheduled.
Follow up December 27, 2002:
He reports, “All these days I was better with no complaints. But I am having acidity and gas since last 4-5 days. If I don’t pass the gas, I get pain in left side of abdomen. Acidity and gas is more after eating. My appetite has reduced a bit. Bowels are regular but not clear as before. Thirst and urine output is same as before. My sleep was disturbed for couple of days but it’s getting better now. I am feeling weak, tired.”
In response to questioning he said, “I had a dispute with my eldest son. He said something that hurt me emotionally. I was sad that day and also felt the pain in my abdomen the same day evening. All these symptoms started after that.”
My assessment: The dispute with son has triggered the symptoms. The history tells me that he is an emotionally sensitive person and he has been affected with similar incidents in past. His energy level has reduced, appetite is low and bowels are not clear. Since the causative factor and symptoms are same as before, I suggested he take a single dose of Natrum mur 200c, which he took on the same day.
Follow up February 18, 2003:
He reports: “I am doing well. The acidity and gas got better in 3-4 days after my last follow up with you. I have no complaints since then. I am eating well. I have started drinking milk every day. I drink 2 cups of milk everyday and can digest it without having any complaints. I feel thirsty and drink 6-7 glasses of water every day. Stools are regular and clear. I wake up refreshed every morning and feel energetic throughout day.”
In response to questioning he said, “Since I have started Homeopathic treatment, I have definitely grown emotionally stronger. I used to feel depressed. When ulcerative colitis was diagnosed, I lost all hopes. The thought ‘I am going to die soon’ used to torment me and I grew more anxious about my family. I used to worry how my family will survive after my death. That hopeless feeling, depression has gone now. Before, I used to weep with memories of my childhood. Now I don’t get that emotional with those memories. I am coming out of my past sufferings.”
My assessment: He was physically and mentally stable. With two doses of Natrum mur 200c his ulcerative colitis improved at the clinical and pathological level as well. Furthermore, Hering’s law of Cure was followed and exteriorization of disease is seen on the skin. At the beginning of treatment he had ulcerative colitis, bloody stools, emotional despair and hopelessness. All these symptoms were indicating that he was under the influence of the syphilitic miasm. But after a single dose of Natrum mur 200c, his symptoms due to syphilitic miasm started improving and he started getting symptoms due to psora (itching of skin with rash, acidity, gas, emotional sensitivity etc.) So the patient has also improved miasmatically. His mental state changed drastically in the last few months and he grew emotionally stronger. No action was taken. He was asked to call if problems returned in the future.
This man was doing follow ups with me further for more than one year. He didn’t receive any remedy in that period. He was fine with occasional symptoms due to acidity or symptoms due to indigestion that got better without any medicine.
While treating this I learnt various aspects of Homeopathy. Most important of all was Herings law of Cure. I could see all corollaries of Herings law coming into action: The direction of cure should be:
- Above downwards: Skin eruptions appeared on face first. Then on back and chest. Then on thighs and lastly on legs.
- From inside out: Symptoms of ulcerative colitis improved at clinical and pathological level and then the skin eruptions appeared.
- From more important organ to less important organ: When ulcer (large intestine) started healing, he got cough and then cold (upper respiratory tract) and lastly the skin rash appeared.
- In the reverse order of appearance of symptoms: Bloody stools (at physical level) and hopelessness (at mental level) were last symptoms to develop as a result of progress of disease process. These symptoms were first to improve after starting Homeopathic treatment. This person was prone to have acidity, gas or symptoms due to indigestion since his childhood. Even after the ulcer was healed completely, he used to have these symptoms though less severe.
I also learnt that the process of cure should be from more serious (destructive) miasm to the less destructive miasm.