Psoriasis is one of the m,ost common autoimmune skin conditions that homeopaths deal with and with success. This case report however, aims at bringing out a few theoretical aspects to be appreciated in practice. Understanding the concepts of Levels of Health as taught by Prof. Vithoulkas are necessary for the clarity and precision in practice.
Psoriasis, classical homeopathy, levels of health
Although many cases of psoriasis under homeopathic treatment have been published hitherto, the intent of this case report is not demonstrating the benefit from homeopathy in psoriasis cases but to delineate certain theoretical points that need to be understood for practical application. Many students are left hanging when it comes to practical appreciation of theory taught in class and this report is directed towards clarifying such doubts.
Case presentation: The patient, a male, age 37 years, came for consultation for the first time on 4th January 2020. He presented with psoriasis of the whole body since 2012. His nails also had been affected and had become brittle and distorted.
The skin had cracks which tended to bleed, especially in winter. There was also offensive sticky discharge from these cracks and from eruption in the umbilicus. The itching was terrible, worse in the night, when he was resting and when he perspired.
He was on Aprezo, an immunosuppressant and Propynate NF, a topical steroid. These helped to a certain degree. He also complained of cramps in the calves during cloudy, cold weather.
Past/Family history: He was the eldest of four siblings, and there was no family history of psoriasis. He did not remember ever getting a high fever and had no remarkable illnesses in the past to relate.
- Thermally chilly patient 3+
- Desire sweets 3+, spices 2+, capsicum 2+, chicken 1+
- Sleep position on right side 2+, wakes up refreshed
- Sexual desire low 2+, loses erection during coition 2+
- Siesta aggravation 2+, headache if takes a long nap
- Thirsty 2+
- Lean and thin body. Present weight – 51.2 Kg
- Sadness 2+, due to stigma of psoriasis. He felt neglected from the family. “I did everything for everyone. Today no one looks at me”
- Sadness, ameliorated by drinking alcohol, by consolation, and listening to religious songs
- Suicidal thoughts occur but he rejects these thoughts due to concern for his children & wife.
Fig. 1. Repertorisation of the symptoms available at first consultation
Understanding from viewpoint of THEORY
In this case, we are faced with the following questions-
- What is the homeopathic remedy needed ?
Graphites is a strong possibility, but it has strong aversion to sweets, whereas the patient has the opposite!
Sulphur is another possibility, but Sulphur is generally thermally hot, where the patient is strongly chilly!
- Can we start with the homeopathic remedy right away?
- What should we do with the allopathic medications?
The patient is using immunosuppressants and topical steroids, which have visibly reduced the eruptions. Only after stopping these drugs, we can ascertain whether the eruptions have been already suppressed or the defence mechanism still has the strength to bring back the eruptions partially or completely on the skin.
For a skin case, these drugs can be stopped under supervision, as the withdrawal effect can be intense but not potentially life threatening. So technically, we should stop these drugs and wait for at least a month before starting homeopathy, else the patient may connect the withdrawal aggravation to the effect of homeopathic remedy.
In this waiting period, there are 2 possibilities. The skin will either aggravate to its original state, signifying that the body has overcome the suppression, or it will aggravate only partially. In the first case, then the homeopathic remedy will bring about immediate amelioration of the skin, provided the case has no pathology on mental / emotional levels.
But in the second case, the homeopathic remedy will first aggravate the skin and later bring amelioration. Thus, understanding of theory, helps to prepare our patients as to what to expect after our remedy. Justifying the above thinking process, the patient was advised to stop the allopathic drugs and ointment and report again after few weeks.
On 29th January 2020 (25 days after the 1st visit) the patient returned, mentioning the following new changes:
- Skin Eruptions have increased a lot.
- Cracks have aggravated and are bleeding from some places.
- Constipation and unsatisfactory stools developed in the last month
- Gets tired easily on slightest exertion in the last 20 days
- Dyspnea on ascending in the last 20 days
Understanding from viewpoint of theory
Symptoms appearing and persisting after removal of allopathic drugs are important indications to reveal the uppermost layer (remedy) needed and these therefore must be combined with the previously related symptoms for repertorisation.
Constipation, easy dyspnoea, and tiredness point to Calcarea carbonica, which was the 3rd remedy in the repertorisation done before. He further confirmed another keynote, a great sensitivity to horrible stories.
With the addition of these rubrics to the repertorisation, Calcarea carbonica was clearly indicated.
Calcarea carbonica 1M, one dose was prescribed on 29th January 2020.
Fig. 2 Repertorisation of symptoms after stopping all conventional medicines
After a single dose of Calcarea carbonica, his energy got much better, he became emotionally much happier, could ascend four floors without breathlessness and in nearly six months, his psoriasis slowly cleared up, starting from the forehead, proceeding downwards, as per Hering’s Law.
Take home lessons
- To see a full-blown generalized psoriasis case accompanied with deep mental emotional pathology (suicidal thoughts), where the patient says that he does not remember his last high fever, appears to be discouraging signs and tempts us to put the patient in Group C (lower level, where chronic inflammatory diseases start making their appearance).
- But Prof Vithoulkas clarifies so beautifully in his book – The Science of Homeopathy, Page 222 – “During the first interview, many clues are discovered which can help the prescriber decide upon a prognosis in the case. A true prognosis cannot be found, however, until there has been an opportunity to evaluate the patient’s response to the medicine. It is at this point that the degree of incurability of a case can be truly determined”
So let us reflect upon the response of the patient to Calcarea carbonica –
- There was pronounced amelioration on the energy level, mental & emotional levels and chief complaint of psoriasis, in a short period, with a single dose of a remedy. Such a significant response would justify putting this patient in upper levels of Group A.
- Despite 8 years of suppressive treatment, eruptions of the patient could not be suppressed and in just 25 days after stopping the drugs, the eruptions resurfaced with full blown intensity, which shows that this patient has a strong defence mechanism. Therefore, it would be correct to assign his level of health to upper levels of Group A.
- After the remedy, there was no aggravation of the psoriatic eruptions which further confirms that all suppressed eruptions reappeared completely after stopping the drugs.
- Seeing the beautiful reaction to a single dose of the remedy, the question arises whether the suicidal thoughts were real. If there was actually a deep pathology present on the emotional level, then the correct remedy would first ameliorate this emotional symptomatology with a simultaneous aggravation of the psoriasis. But this somatization, which we observe in a curative process of deeper cases involving the mental/emotional plane, was not seen in this case, ergo the conclusion that the mental emotional symptoms (suicidal thoughts, sadness) in this case were not pathological, but were reactions to social perception of his appearance. It was a superficial sadness.
- As this patient belonged to upper levels of health, we could witness such a quick resolution. We cannot expect such cures in all cases of psoriasis, especially when the patient belons to Group C & D (lower levels of health).
- Thus, the Levels of Health is an invaluable clinical tool as it advises a homeopath on every aspect of patient assessment.