A very interesting case with many ups and downs in her life came to me in May 2017. She had numerous problems regarding her personal as well as social life. Her main trouble was frequent attacks of cold and coryza every time she is exposed to strong odors, perfumes, oil, phenol etc., which has persisted for six years. She used to get violent bouts of sneezing with profuse thick yellowish mucus from nose along with much lachrymation exposed to such things. She feels better in open air and her complaints get worse towards evening. Her right sided nostril is always affected first with much obstruction in the evening and at night. She gets pain in the temporal region with pain in right ear on and off, and it become worse when she gets the attack of rhinitis.
She got married at age 12 to a man of 40. She lost her parents when she was just 4 years old. She has 3 elder brothers but the wives of her brothers treated her as a slave and forced her to marry that man. After she got married, she to take sleeping pills every night since her marriage. Her in-laws didn’t like her and treated her as a slave. They tortured her mentally as well as physically. Her husband was a drunkard and one day he quarreled with his sister and left home to drink more that day. After few hours somebody told her that her husband burnt himself, but the truth was that attempted suicide and subsequently died
Her in-laws used to beat her until she bled. By that time she was pregnant and she was in her forth month of gestation. One day her father-in-law tortured her so much that she had to leave her husband’s place. She tried to contact her brothers but her brothers refused to protect her. She walked to the railway station and got on a train. There she met a young man who consoled her. She eventually married him.
Three months back she had chicken pox and she has GI troubles since many years. She gets burning pain in epigastric region on and off. She cannot take fatty or oily food as it aggravates her complaints. She is a non- vegetarian. Her appetite is reduced since the last few days. She is thirstless when she gets the attack of rhinitis but otherwise she is thirsty. Her sleep is disturbed and unrefreshing. She feels somebody will kill her and strangle her if she sleeps. She is restless during sleep. She had no specific dreams as such. Her menses were irregular, delayed and painful; also the flow was scanty only for 1-2 days. She becomes irritable before menses. Her obstetric history reveals that she had an injury during her first pregnancy at 4th month, but it was a normal delivery. The second was also a normal delivery. Thermally she is hot.
No strong family history of any illness was found. She used to take levocetrizine on and off when the symptoms of rhinitis were much worse.
She is a mild gentle lady, emotional and a bit religious. She is caring and helpful, also loyal to her husband. She feels neglected by her own family but now she is happy with her second husband and her two children. Although she had gone through such a tragic phase in her life, she had a smile on her face, which shows her strength and optimism.
On local examination there was a small polyp inside the right nostril with slight congestion. Her throat and ears shows no abnormality. Also there was no tenderness in the Paranasal sinus areas.
She is of 5 feet 2 inches tall, emaciated, malnourished and of 42 kg weight with slight pallor. No lymphadenopathy, icterus, eruptions, cyanosis or any edema was detected. Her B.P was 110/70 mm of Hg and pulse was 70/min, respiratory rate was 18/min and she was afebrile. Her tongue was dry and clean.
Analysis of the case
Most characteristic part of the case-
- Ailments from grief and lack of love
- Caring nature
- Neglected feeling
- Restless at night
- Fear of being killed during sleep
- Hot patient
- Irritability before menses
- Aversion to fatty food
- Thirstless during attack
- Sneezing on exposure to strong odors
- Thick yellowish discharge from nose
- Nose blockage in right side
- Aggravation in evening
- Desires open and fresh air
- Pain in right temporal region extending to right ear
- Clean dry tongue without thirst
Most probable remedies were- Pulsatilla, Nux Vomica, Sulphur, Phosphorus, Natrum Mur
Ailment from grief, optimistic, caring, affectionate, religious, neglected feeling, irritability before menses, irregular menses, fat aversion, thirst less, thick yellow discharge from nose in evening, open air amelioration, nasal obstruction in evening.
Loyalty, fear of being murdered, sneezing odors from, nasal obstruction in right side
Ailment from grief, optimistic, affectionate, religious, irritability before menses with irregular menses, fat aversion, thick nasal discharge in evening, better in open air, pain in right temporal region.
Caring for others, loyal, fear of being murdered, fear of being neglected, thirst less, sneezing from odors, yellow discharge from nose in evening, pain in temporal region.
Ailment from grief, optimistic, caring, affectionate, religious, irritability before menses, irregular menses, fat aversion, thick yellow discharge from nose in evening.
Loyal, fear of being murdered, fear of being neglected, thirst less, sneezing from odors, pain in temporal region, better in open air.
Ailment from grief, affectionate, fear of being murdered, irregular menses, fat aversion, sneezing from odors, thick nasal discharge, nasal obstruction in evening
Loyal, fear of being neglected, thirst less, sneezing from odors, pain in temporal region, better in open air, optimistic, caringreligious, irritability before menses,yellow discharge from nose in evening.
Ailment from grief, affectionate, loyal, religious,irritability before menses, irregular menses, fat aversion, thick nasal discharge
Fear of being murderedfat aversion, sneezing from odors, nasal obstruction in eveningpain in temporal region, better in open air, optimistic, caringreligious,
Pulsatilla 200 single dose was given as the simillimum and placebo 2 pills BD was given for 15 days on 14/05/2017. ( See explanation in Summary below)
1st follow up
She said she was better for 3 weeks after taking the medicines, but since two days similar complaints started after exposure to the strong odor of paint in her house. Her appetite, sleep and bowels are improved also the polyp size on right nostril was much reduced.
One more dose of Pulsatilla 200 was repeated on 09/06/17 with placebo for 15 days.
2nd follow up
She came on 23/06/17. There were no episodes of rhinitis even if she was exposed to strong odors. No polyp was seen this time. No medicine was given. Only placebo was given for 15 days.
3rd follow up
She came after almost 1 month on 30/07/17. No episodes of rhinitis were there. She had fever since 2 days with much chilliness, increased thirst, slight dry cough without expectoration, she was restless at night. Her temperature was 1010 F at that time. Arsenic alba 1M – 1 dose was given as acute prescription. Placebo for 1 week.
4th follow up
She consulted on 12/08/17 with violent episode of rhinitis with much sneezing and profuse lachrymation. Thin, watery discharge from nose was there 2 days back and there was nose blockage with difficult breathing. Considering her acute symptoms and also the changed picture of the symptoms Natrum mur 1M single dose was given with placebo for 15 days.
5th follow up
She consuilted on 26/08/17. This time she was much better. No episodes of rhinitis were there. Her appetite and sleep was better. Placebo for 15 days was given.
6th follow up
No attack of rhinitis. She came on 10/09/17 for pruritus vulva since 2-3 days with much burning after scratching. There was itching on her back with slight reddish eruptions since 2 days. All these complaints are increased at night. Sulphur 1M single dose was given on acute totality with placebo for 15 days.
7th follow up
She consulted on 26/09/17 with no complaints of pruritus vulva or any itching on back, no eruptions were there. Her GI trouble which she had before was also gone. No attack of sneezing.
8th follow up
On 15/10/17 she arrived with no complaints. She wanted to continue the medicines. Placebo was given for 1 month.
9th follow up
She came on 02/11/17 with complaints of amenorrhea since 2 months. I advised her for urine pregnancy test. She did accordingly and she was pregnant. She wanted to abort the child because her second child is just 2 yrs old but I advised her not to do that and continue her pregnancy. No medicines were given.
10th follow up
On 20/11/17 she came for complaints of unsatisfactory stool and nausea since 1 week. Appetite was much reduced. Nux vomica 30– 2 pills BD was given for 3 days considering her acute complaints.