1st consultation: June 2009
The case taking technique is based on Dr. Rajan Sankaran’s Sensation method. All the efforts here are to observe the energy pattern of the patient and to find out the vital sensation, level of experience, kingdom, sub-kingdom, miasm, & source.
D: What are your problems? Describe them to me in as much detail as you can.
P: As of now I have severe knee joint ache. That’s my major ailment. Rest…..just the other day had a little cold…..and then my stomach……earlier had this problem of acute acidity…..now I have regularized my life style accordingly….so it is not as much now…..but still don’t have that well being feeling most of the times……I do pranayam…..but that time I feel my breath to be insufficient. Stomach ……is never clean…..that lightness….that feeling I don’t get many times. So as of now I don’t have any major ailment. Just that my knees pain a lot. I do have spondylosis but…… have it because of my job I guess…..don’t get giddy or anything of that sort, but in cold season my neck pains a lot. Then I can’t work with this hand …..Can’t lift or twist ……strength is not there……just in the winters there is this problem otherwise I don’t have so much trouble.
D: So tell me what bothers you.
P: Knee pain
D: What exactly happens…..just explain your trouble?
P: Actually right now there is one exercise I do……while doing that , while getting up, my knees pain a lot…..while descending the staircase there is a lot of trouble, sometimes while getting up there is trouble…..and my movements are restricted, movements such as standing and sitting.
D: This means what?
P: It means sometimes I feel I shouldn’t get up…..even the thought of it makes me feel I should not even try to get up……..We don’t have the western style toilets …so to get up after squatting is difficult……
And descending the staircase is too painful. Morning it does not trouble that much. But as the day progresses it starts paining a lot…mornings I am much better. I can sit down for quite sometime though….all classes are done by sitting down only….if you sit down you can at least change the position of the legs, move them….even if I sit cross legged my right knee pains a lot …..Then I change the position and sit …..Though I sit down for 1 hour or so….not that I can’t at all sit, but while getting up there is a lot of pain.
D: Tell me a little more.
P: This shooting kind of pain……in my joints….I can feel some dryness.
P: You can actually understand how it would feel like, in an unoiled machine (HG: Shows a rotator motion with the right hand)
…that’s what it feels like….Then I get depressed quickly……I feel that I have become really very old because that’s how my movements are…….though I have aged but then I feel aged more that what I am. It is unbearable. That shooting pain that I get is bad. How do old citizens descend the stairs?!…… Sometimes I am walking down the same way……I can’t even descend the staircase in a normal way.
D: Tell me a little more about this.
P: Even at night if you sleep taking your legs close to you …that time also it pains…. Immediately feel like making them straight. Means when my leg gets folded that’s when it pains I guess. In a certain position when my legs get folded, my knees pain more. If I am walking straight then I don’t get so much pain. See now I am sitting here, after I get up, say after half an hour, my knees will definitely pain because while sitting, they are getting folded a little…. I mean the pains that I get….its paining because its all dry…that’s why it is paining….that is just the feeling I get….like as if it is getting rubbed over each other, how would you feel? That is how it is……
How old people look for a support……for any reason …”why am I needing that kind of support” is what I always feel…. The pain is so severe that I need a support while climbing down stairs. If the support is not there wont I, be able to climb down? There is a lot of limitation on my movements….. Say if the stairs hasn’t got railings on the either side it would be impossible for me to get down with the pain. It would be quite an effort to do that.
D: So tell more about the example that you gave me about how would it feels if a machine is not oiled….or how would old people walk, or there is limitation on your movements ……explain that thing to me a little more.
P: Yes limitations meaning ……I tell myself if there is staircase then let me not go at all, as it is going to trouble me….. I will go when I have some extra time….means if it is my class time , say at 4:30 is my class , then I have to leave 5 minutes early …..Or don’t go there at all….since I will have to take the staircase then forget it, it would be better if I don’t go. The attitude tends towards avoiding things…….or else always have to calculate that I am going to need some extra time, have to consider that. It is always at the back of my mind that now since I have to descend the staircase my knees are going to hurt, these thoughts are always present in my mind. It is quite an effort to climb up.
D: Tell more about…..movements are restricted, like dryness inside, machine not oiled or there are limitations, just explain this to me.
P: Limitations means you have to take a lot of efforts to go up. Whatever is to be done you feel no, don’t do it………From inside the joints are getting scraped, so I am getting the pain, is what I feel.
D: Explain these examples that you gave me……..what were you saying?
P: (Laughs) …see even the door hinges if they are not oiled (HG: both Index fingers, flexed & interlocked showing no movement) then also they make a sound…..kar, kar……when oiled the movement gets better it becomes smooth (HG: Same Gesture showing movement)…..that is how the up and down movement of my knee joint there is in pain. So I feel that there is nothing there, so I get the pain. It gets scraped, that’s what I feel.
D: Just talk in detail about that scraping, dryness or that machine example …….talk about that example in detail.
P: If the window is not closing well, then don’t we oil the hinge so it opens, closes, bends (HG: of the index fingers)…..that is how it is …..I am getting the pain because it is getting scraped on each other. That is just what I feel. While walking straight I am not having any trouble. But only when my knee folds, it pains. Dint I mention it to you that when we sleep talking our legs close to our stomach even then it pains. If I straighten my leg I feel better. Then even if I feel cold to take my legs close to my stomach and sleep I avoid. Thus are the limitations. And the feeling that I was talking to you about I get while walking up and down the stairs. Even the tongs if you see, the joint of the tong gets hard, it does not bend or does not come close (HG hands coming close, and moving away), even there when we do that (HG: gesture with force) only then the movement gets smooth. That is how should be even, my movement. Why is that pain there? That strain, the movement is thus not smooth.
P: It means when it is not there, the lubricant (HG), you have to do this, there is a lot of resistance (HG: does the gesture with effort, with more force).
D: What do you mean?
P: You need to stretch it (HG: same gesture of the hands but applies more force to do it). The tong, if are not moving properly, then we have to pull it out (HG) and push it back (HG) The tongs in my kitchen are new, that’s why I thought of it now. It easily does not happen like this. You have to push it with force, and pull with force (HG). So lubricate it a little, it starts working quite fast. It gets a little loose, the tongs. When it is tight you have to use force to pull it (HG). And when it gets loose then the movement gets much better (HG: Moves her hand as if using a loose tongs…with less force). That’s what I feel has happened to my legs. While putting my leg down from a height it does not become properly like this (HG: Stretches her fingers apart). It has got tight (HG).
P: Meaning that they are entangled tightly into one another (HG).
P: Meaning the two things do not happen this way. (HG: Crosses one finger of each hand and moves it to show movement). They just stay tight on one another. That’s what happens here, I feel. It is as if they have got stuck into each other.
D: Tell me more?
P: Means the movement is not there. They are stuck into each other (HG: No movement). They do not move like this (HG: easy movement).
D: What are you showing with your hands? Just explain this.
P: If this is the knee joint, (HG: Two fingers crossed and moving). Then the movement like is not there at all. It is just like this (HG: same gesture with force).
D: Like this means?
P: Don’t move at all.
D: Don’t move means?
P: If this is the joint then it just does not move like this (HG: Same gesture with less force). It takes a lot of efforts or resistance to move it.
D: Forget about the joints. The example that you are talking about, where it is tight and so no movement, explain that thing. Talk about that tightness or no movement!
P: The hinge of the door, sometimes we have to push the door open. But if we oil it moves with ease, isn’t it? The hinges are there…..even they are crossed over each other tightly, when oiled they start moving. Even the sewing machine, the down thing which rotates (HG: Palm moving too and fro) that gets tight sometimes, when you oil it, it moves and goes ahead. Till then it stands still. (HG: Fist closed).
D: Describe this stand still. What do you mean by stand still?
P: Means even if you put in effort it does not go ahead. If you put pressure or……..still it does not go. (HG: hands pressing downwards as if putting pressure). How much ever you try……..it does not go. Then you have to put in some external means to make it move, say like oiling. Then it moves smoothly. Smoothness should be maintained. And not just your joints, but even in your life there should be this smoothness.
D: What do mean? Explain.
P: Means it should be smooth (HG). If we decide this and this has to happen, so all that should actually happen.
P: Say if we have chalked out the whole day’s routine…cooking, exercise, meditation, etc…..if I have to call up anybody then all this happen all in line. There shouldn’t be difficulties in all these jobs.
P: Anything can happen. Say there is electricity failure, so few jobs can’t be done. There shouldn’t be such obstacles. Or if today I have to go for my class, and I am not able to go, or go but don’t learn anything, such simple things actually.
D: So, not just the movement of the joints but even your life………..what did you say?
P: Yes, smoothly or easily, rarely things flow. Always some resistance, some energy has to be used up.
D: So rarely do things flow. And that resistance… explain that a little.
P: There should be consistency in a thing. If I have to talk about a simple thing, that my daughter has to conduct her classes, she should get 2-3 hours for herself that time, it should be possible daily. They should be conducted at their decided schedule.
D: Yes! That I understood. Keep the situation away. You were talking about that flow, and there shouldn’t be any resistance, meaning what?
P: Means there is a stoppage in that flow (HG: Right hand semi prone and shows a stoppage). Now when I go from here at 8 pm., I have to go and have dinner, then a small walk, meet a friend, then will be back home. And in explaining my schedule if it is already 9 o’clock, then ill go home, so nothing of what I wanted to do, will be possible for me to do. We manage our time, after discussing with everybody, so that everything should be smooth, no wastage of time and energy, so that I can use it for my happiness somewhere else. Health is the prime thing. So when I feel that in the morning if I have not been able to concentrate on my meditation, then I feel let me try at night again, if I can do it? So till 10pm if I have wasted my time, then when will I have dinner, clean up stuff, then when will I get time for meditation?
D: For two minutes just try and think about what you said, that there is a flow, and then that resistance, just explain this sentence to me. It is not necessary that it’s related to your life or your situation. Generally when you think of this sentence that there is a stoppage to the flow…….(Interrupts me)
P: Stoppage to the flow means, the same thing, it came to mind as a flow, that my thoughts get disturbed. Anytime there can be a stoppage. Mentally also I can face the same thing then, my concentration gets affected. Say if there is a musical program, the audiences and the singer and all involved in it, and suddenly if nearby traffic starts horning loudly, there is naturally going to be a stop, and even the people listening are going to get disturbed. It just stops! (HG: Holds palm straight). The link is broken. The singer has to all over again put in effort to produce that note….
Or if the water is flowing, something suddenly comes in between, so for sometime the water is going to collect, until some sufficient amount of water…….thus the flow gets interrupted. It cannot flow ahead. Even if you see a water body in the farm, it is channelized so that it reaches a certain area where it is needed, and in between it gets……….(HG: Rt. Hand semi prone on the table), then it does not reach where it is supposed to, and it changes course and flows somewhere else. So that water is wasted, and the area which needed water gets no water. It just gets wasted! You need to make a different channel all over again. So nothing is gained, and there is just wastage. That wastage also saddens you.
Here is a 56 year old lady who came to me for her knee pains in June 2009. As she started describing her complaints she very quickly went on to give me various local images to describe her chief complaint.
- A machine which is not oiled does not function smoothly, makes a Kar-Kar sound due to dryness
- A new pair of tongs that need a lot of force to stretch it. Does not work smoothly.
- Old people needing a lot of effort to go upstairs
- Limitations of movements…
In all these above images what was running through and through was the feeling of something not working smoothly and facing a lot of resistance. And a lot of effort is needed to make it work smoothly. Here even the force in the hand gestures used to describe the resistance and smoothness was beautifully noticed. Whenever the patient described resistance she used a lot of force to show it with her hands, and whenever she described smoothness she did it with ease. On further asking to describe this smoothness and resistance she connected it to her entire life situation by saying there should be smoothness not just in the movements of the joints, but even in your life. Here she generalized the feeling of smoothness. Later with more life situations and images she described the entire pattern of something obstructing, limiting, and restricting the flow or the smoothness and a lot of effort is need to get the smoothness back.
For analyzing the case it is important to look at the following aspects.
- The Vital Sensation & Energy pattern
- The kingdom
- The Sub-Kingdom
- The Miasm
- The Level of experience (to select the potency)
- The source
The Vital Sensation:
Something obstructing, limiting, and restricting the flow or the smoothness and a lot of effort is needed to get back the smoothness. (Shows with hand peculiar gestures)
The Kingdom: Plant Kingdom
In the entire case what is prominently seen is
- Only one sensation of obstructing, limiting, and restricting the flow and the opposite of it, that is flow or smoothness.
- All the examples given by the patient are just to explain this feeling of obstruction and smoothness. It just demonstrates the quality of the sensation.
This is very typical of the plant kingdom. There is no issue of you versus me, competition or survival issue as seen in the animal kingdom. Neither there is any issue to do with making or breaking of the structure as in the mineral kingdom.
The Sub-Kingdom: Crucifereae family
The remedies of the crucifereae family share the following sensation
Vital sensation: Obstruction mentally as well as physically
Passive reaction: getting stuck, interrupted flow, no way out
Active reaction: breaking the barrier, moving ahead, smooth flow, clearing the
Compensation: Blocks do not bother me
The miasm: Ring-worm
The intensity with which she feels the sensation will tell us about the miasm. All throughout the case whenever she talks about obstruction she talks about making a lot of effort to bring in the smoothness. Her attitude is of trying and avoiding. This suggests the ringworm miasm.
Level of experience: Delusion
She was in touch with her imagination at that given moment of time. This made me think of the delusion level.
Remedy: Sinapis Alba
According to Dr. Rajan Sankaran’s understanding of plant remedies the cross point of the miasm and the sensation gives us the remedy. The remedy in the ringworm miasm for crucifereae family is Sinapis Alba.
1M potency is equivalent to the delusion level. So 1M was selected.
Both the knee joints showed crepitation and synovial effusion.
The X-ray confirmed the diagnosis of Osteoarthritis.
R.A. factor was negative.
- An insight into plants Vol. 3 by Dr. Rajan Sankaran
- The Sensation in Homoeopathy
Follow up: (July 2009)
D: Hello, How are you doing?
P: I am better. The knee pains are more than 50% better. I take less time to go upstairs. And I am feeling happy (smiles).
D: Ok, what else?
P: My sleep is good. I am not feeling tired anymore.
D: Any other improvement?
P: Nothing else.
D: How is that feeling of limited movements that you told me?
P: That is a little better. Sometimes I do get it but not always. Certainly a little better!
Follow up: (December 2009)
D: How are you?
P: All right.
D: Knee pain?
P: That is gone. I am walking very comfortably.
D: How are you otherwise? Mentally. Emotionally.
P: I am doing fine. Very positive in my approach. Not getting depressed anymore. Not feeling blocked.
P: Yes…the block has gone somewhere. Things are smooth now!
Follow up (February 2010)
D: Tell me?
P: I have fever since 2 days and throat pain.
D: What is happening exactly?
P: I had gone to Mumbai in an A.C. bus and due to the cold air I started sneezing. Yesterday I got this horrible pain in the throat and fever.
D: Tell about the pain
P: It is a terrible pain. Like sharp pins. It hurts a lot while swallowing. I am constantly drinking hot tea. That is saving me somehow.
D: Sharp pins means?
P: It is hurting. It is so very difficult to swallow.
D: Difficult to swallow means?
I have to put in a lot of efforts to swallow even saliva. It hurts
D: What is the exact feeling there?
P: There is this sore spot and I have to swallow above it. It comes in the way
D: Comes in the way?
P: Yes, like a speed breaker. I have to swallow above it.
D: What do you mean?
P: There is a thing inside, a pointed sharp stone that blocks the airway. I cannot swallow smoothly.
The same sensation comes up here. fI we had not had the background of the case we would have waited with the pin like pain and hot liquids ameliorate and given Hepar Sulph. But this local delusion took me again to the deep rooted sensation. So I repeat the same constitutional remedy.
PLAN: Sinapis Alba 1M in a half cup of water. One spoon to be taken every 2 hours.
Explanation: The remedy was repeated often after 2-3 telephone follow ups. What I could see is that the effect of one dose used to wane after 2 hours, so I repeated the remedy every 2 hours. She recovered in 3 days.
She still follows up with me and is doing very well in all aspects.
The remedy was selected after referring to Insight Into Plants Vol. 3 and The Sensation in Homeopathy by Dr. Rajan Sankaran. The concept of kingdoms, sub-kingdom, miasms and levels of experience has been applied to solve the case. This technique of case taking focuses on finding the vital sensation and observing the energy pattern (hand gestures etc).
Good one Atul, a nice case-presentation.
Keep it up.
Thank you Navneet…!
Your patience on the patient are commendable, Dr. Atul. Wonderful. Thank you.
Thank you Dr. Nisar for your kind words…
I thought it was bryonia,much dryness feeling.
I dont know about your prescribed medicine so I have to know it.Thank you for posting your case.
Thank you Dr. Talha for your comment.
I certainly thought of the Bryonia and the Violales family as the dryness, smoothness and stoppage gives us an idea of disturbance and the opposite sensation of smoothness. But then the difference that i could see was that the dryness led me further to obstacle and stoppage. This stoppage is like a complete block in front of you…like a dead end(cruciferae) and not just a mere disturbance or irritation(violales). This she beautifully describes in the water example, how the water channel is blocked and it has to find a new way. Hope it explains your doubt….!!
Innovative Ideas and new approach may make Homeopathy successful. B happy
good case doc keep it up.
Thank you for publishing this case… very clearly explained.
Just experienced a case I understand to be Sinapis Alba as well. Dryness was also a theme… a desire for water to flush out and move through.
To be sure I will have to wait for a conclusive follow-ups..