This article was originally published in Similia – December 2009 Volume 21, # 2
Ambra grisea is a well known remedy for old people, but it is also has a less well known constitutional picture. In this case I initially prescribed two well known polychrests to which the patient responded well, but developed a proving symptom. Further work on the case led to a much better prescription, of the less well known remedy, Ambra grisea.
This article is in two parts: part one is the initial consultation with follow ups, prescriptions and analysis. Part two discusses the subsequent analysis and consultations and looks at the remedy Ambra grisea.
This is the case of a thirty four year old unmarried woman. She first came to see me in April 2002 and continued to be a patient until 2007. She was working as a nanny. Presenting complaint: ‘stress in my job leads to headaches’. Jaw aches, heavy – have to lay it on a cushion. Diet can be good – bad extremes, lost 30lbs in the last year. Can lie awake thinking about work (2). Nanny to two children ages 11 and 12. Personal Assistant to the family and help with house move and errands; work hours affect social life. I’d like to leave, trying to find courage to tell them. Not sure what to do next. Job includes flat.
The mother of the children where I work is hard work [is hard to please], she is neurotic and paranoid. I don’t feel appreciated by her. It never calms down. Known them and worked for them for 10 years, only had two other jobs. Lot [of emotions] crammed inside me. Due to have a talk with the boss, accept or leave……I want to say ‘I quit’. I get upset when talking about things with her. Her direct way of talking makes you feel small. Don’t get thanked. I don’t like things that she does with the children [way she treats them]. I wake up at 3am and read for 2-3 hours. Thinking ‘What could I do instead?’Employer [the mother] wants me to do more computer courses, budgets, working out costings.
Think would enjoy having children myself. I’m not very approachable. Very self conscious when I go out. I was tall, stood out, looked at when I was a child at school (3). It is hard to walk into a room by myself. I am quiet not outgoing, have my own set of friends, reserved. Don’t want to draw attention to myself. I think that others make fools of themselves (2). I often go to work early. I go away every other weekend to stay with friends or family. I count on old friends. My parents died when I was 15. Both had sudden cancers. My brother is 15 years older; I went to live with him. I get very upset every few months when I am by myself. I had spells of depression even as a child.
I am a very hot sweaty person (3) worse for change of temperature, worse at work, worse for sugar. I perspire on my face, stomach and back (3). I love chocolate and cheese. I can get diahorrea from eating cream (2). I don’t remember my dreams. Menses are every 28-34 days. I used to faint when younger, felt better lying on a cold floor. Achy legs at night during period (2). Snappy, impatient and weepy before menses. Did my first diet at 16, weight goes up and down. Bowels not regular; stool twice a week. Fear of bowel cancer.
Prescription: Natrum muriaticum 1M based on reserved, silent grief, dwelling, thoughts persistent, face perspiration, pain uterus extending down the thighs, rectum inactivity, chocolate desire and other rubrics.
First follow up 15/5/02 five weeks later. Headaches gone after two weeks. Feeling a bit better. Had quite a few bruises. [New symptom] Energy wise, mood happy, Sleep fine (3). Can’t stop eating. Couple of talks boss – money, holiday time, stood up, defended myself (3). Angry not tearful (2) .Would like to stay another year. Not a good time to leave for the children. Perspiration not so bad (2). Achy legs did not notice, and can’t remember.
Prescription: Wait. Good response to the remedy, except for the bruises, a new symptom.
29/5/02 telephone call – seven weeks since prescription. Sleep deteriorated, thinking about things, jaw feels strange.
Prescription: Symptoms have started to return, repeat Natrum muriaticum1M
9/7/02 second follow up eight weeks later. Headaches never returned. Jaw symptoms did not develop. Bruises long lasting arms (3).Work busy, hate holidays, try to keep out of her [the boss’s way].Avoid issues; don’t know how I would say I’m leaving. What to do and her reaction, she would make me feel very guilty. Perspiration the same (2). Aching legs not remembered. Menses teary, did not want to go out. Constipation: stool every other day rather than twice a week. Sleeping and headache definitely better. Feel more confident, going out more. Social life picking up. Last 2 weeks felt better.
Prescription: wait, but the bruises are a concern.
2/10/05 telephone call – twelve weeks since last prescription. Poor sleep since return from USA. Bad period pains with fainting at weekend. [Old symptom] Bruises, still got one big one.
Prescription: Carcinosin 200c on basis of poor sleep, family history, relationship to Natrum muriaticum AND concern about bruises when takes Natrum muriaticum.
Third follow up 11/3/03 twenty three weeks since Carcinosin. Ache in jaw just returned. Problem sleeping again. Hotness has been a lot better (2). Still don’t like employer, but less stressed about it. Diarrhoea when nervous/ worried about dates. Stool now daily, used to be constipated. Periods better, no achy legs. No bruises.
Prescription: Natrum muriaticum 10M. As there was such a good reaction. In hindsight I should have repeated the Carcinosin.
Telephone call 28/4/03 seven weeks since Natrum muriaticum 10M
Jaw pain took longer to go. Poor sleep, hot and bothered. Hot perspiration returned.
Prescription: Carcinosin 1M, at least no bruises from the Nat muriaticum this time!
17/6/03 fourth follow up – seven weeks after Carcinosin 1M. Poor sleep again, lot going on at work. Wake up all the time, very early 5-6am, not get back to sleep. Friends got problems. Job is finishing. Trying to keep cheery for others. Bit down and blue. Death in employer’s family. My best friend told me two weeks ago that she had marriage problems; I am in shock. I don’t want to tell our other friends about it. Best friend had everything. I take on others problems physically (3). Remedy did not work in same way; last year was instant, never got back to normal this time. No headaches. Perspiration bit better. No constipation. No achy legs with menses. I had a dream, I hardly ever dream. I was in an airplane hangar with rows of women. Afghan men were patrolling collecting our urine, I couldn’t go. [urinate](2).
Prescription: Natrum muriaticum 10M
Rubrics from Synthesis 9.1 repertory:
MIND- COMPANY-aversion to -strangers, aversion to the presence of-urination, during
This gives three remedies Natrum muriaticum, Lycopodium and Ambra grisea.
Fifth follow up 21/7/03, five weeks later. Stressed, in charge of moving everyone whilst boss is away. Big black bruises. [Definitely a proving symptom of the Natrum muriaticum].Wake very early 5am, not able to get back to sleep. Constipated. I have hurt my upper arm. The pain extends to my neck. Pins and needles [tingling/numbness] in fingers, as if have been lying on my arm. Difficult to sleep on my right side. Physiotherapy had helped a little. Hotness improved. No headache. No dreams.
Analysis: As the follow up showed, Natrum muriaticum did not help and as I understood the case there was no similarity with Lycopodium. I therefore decided to look at Ambra grisea on the basis of the previously selected rubrics.
I also included additional rubrics based on the information obtained over a number of consultations:
SLEEP-SLEEPLESSNESS- thoughts-activity of thoughts; from
MIND-LOOKED AT; to be- cannot bear to be looked at. [The patient spoke in the first consultation of how it was hard for her to walk into a room by herself and that she did not want to draw attention to herself].
MIND-AILMENTS FROM -death of loved ones [both of her parents died suddenly when she was 15].
Looking at materia medica I also found the following information ‘At night the right arm frequently feels numb, and goes to sleep, (Allen); ‘numbness runs through the remedy’ (Kent).
Prescription: I prescribed a single dose of Ambra grisea 200c on 21/7/03.
Sixth follow up 23/9/03 The patient returned two months later, to say that the pain in the arm had just returned two weeks ago. She had tried physiotherapy, but that wasn’t helping. Sleep was ok. There were no bruises. Constipation was mostly fine, but she had been constipated a few days this week. She had left her job which she had been talking about doing for 15 months.
Prescription: Time to repeat the remedy, Ambra grisea 200c.
Telephone call 15 days later – Patient telephoned to report that the shoulder and everything else was much, much better. Sleep was ok. She was better instantly, the next day after taking the remedy.
One month later shoulder and arm still better. Pain returned four months after the second prescription. It had been repeated in-between for sleep problems.
27/1/04 slight return of shoulder pain, problems around eating -uncontrollable. Dream ‘something in my body seeping out, black oil’ (Boericke) ‘Ambergris – [is] A Morbid Secretion of the Whale’.
Prescription: Ambra grisea 10M
11/5/04 shoulder pain returned slightly Ambra grisea 10M
27/8/04 shoulder still good.
3/11/04 the patient reported that she was very self conscious dating [MIND- ANXIETY – company; when in], face pain in the jaw returned. I have just met someone [a new boyfriend], I am so nervous and stressed. Nervous tummy, stool 2-3 times per day. I can Text him or talk to him on the telephone but if I had to meet him I thought I would throw up. I feel very self conscious. I might trip up, run out of things to say, wonder why he likes me. I go over everything in my mind; I am scared about the future. If had to meet his friends and family? Prescription: Ambra grisea 10M
Seven days later 10/11/04 jaw pain nearly gone, nerves better.
It can be seen that Ambra grisea can be mistaken for Natrum muriaticum. Kent (1987) writes that Ambra grisea is analogous to Nat muriaticum; but with Ambra grisea there is the extreme embarrassment. Vithoulkas (1995) has written a lovely description of the Ambra grisea state in his Materia Medica (1995) and he too refers to the similarity with Natrum muriaticum, as does Linda Johnston (1996). Reading Vithoulkas (1995) again confirmed the remedy in the patient’s acute state of anxiety when dating. ‘The key word that best describes the mental emotional state of an Ambra grisea case is INHIBITION. Most of the symptomatology of this remedy revolves around the idea of not being able to loosen up, to relax and ‘exchange’, to let go when in the company of other people.’ An anagram of Amber grisea is E M B A R R I S.
On 1/2/05 the patient told me that her shoulder pain was caused when her friend’s boyfriend left her when she was pregnant [this was the friend’s marriage problem that she referred to on 17/6/03 – it has taken her 19 months to tell me this! And you see how embarrassed/reserved she is in that she originally referred to her friend as ‘married’].Weight can go up and down 3-6lb in a week.
20/1/06 the patient comes to me a few days before the first holiday with a new boyfriend, before meeting his parents and talks of her difficulty in expressing her feelings. ‘They are so inhibited, and timid and easily embarrassed that it is very difficult for them to establish a relationship’ (Vithoulkas) ‘As soon as he goes into company there is flushing, trembling, nervous excitement and the thoughts vanish. With these symptoms the patient imagines that he is going out of his mind, and finally he settles down into a state of melancholy, sadness and despair, and does not want to live’ (Kent). She also mentions a hemorrhoid problem, ‘had it on/off for 10 years, not told you before’.
(Other occasions on which I have prescribed the remedy have included a woman, previously prescribed Natrum muriaticum and Pulsatilla, with a history of many deaths and blushing. ‘There is, however, one aetiology which is very specific for Ambra grisea. The particular circumstance is the loss of relatives, specifically ‘the deaths of one after another in the family’. (Johnston). The remedy is listed in black type in the rubric ‘Ailments from grief’. Could this be related to the massive hunting of whales over the centuries? In the above case the patient’s parents both died suddenly when she was 15. I have also prescribed the remedy with some success in a case of asthma following business failure. Ailments from business failure (Kent, Johnston). Ambra grisea is often thought of a remedy for old people. Roger Morrison (2007) talks about senility, premature senility, prattling, silly loquacity which are not elements of this case.)
Ambra grisea case quotes and themes
SELF CONSCIOUS, EMBARRASSED
‘Met someone, so nervous and stressed, nervous tummy, stool frequent, can text, talk on phone, but if had to meet him thought I would throw up. Feel very self conscious, might trip up, run out of things to say, wonder why he likes me……will my friends like him, my family, is this the one? Go over everything in my mind, scared about the future, if had to meet his friends and family…dry mouth, shaky, nausea…did not want to eat in front of him…where will it go, what happens next?
Not good at sharing my feelings, worry he will go off.
Not good at saying nice things, spoil the moment…hate him to turn it into a joke.
Meeting his parents for the first time could affect sleep, thinking of conversation ideas….feel sick.
Problems communicating things…thinking too much, not able to put into words feeling of love.
Pulling away a bit…not returning someone else’s feelings and compliments…could not say something that not feeling…going on holiday together this week….how to get to next bit?
To go to his family house at Christmas [now September], only seen them in restaurants. Very nervous and self conscious….think first before speak…come across as not the best I could be.
Stayed with his family feel so self conscious.’
[This aspect does not come out in the materia medica, but is not surprising from what we know of the natural history of the Sperm Whale Physeter macrocephalus, they can gorge on massive amounts of food and yet also go months without eating] . ‘Hard to control how much I eat. Weight up and down. Gained three pounds in a day. Eating large amounts was off food [not interested in eating]. Hard to control how much I eat. Diet all week then eat loads at weekend….put on five pounds on Sunday. Age 15-17 tall podgy big stood out much bigger than everyone else, first diet at 16.’
‘Meeting his parents for the first time could affect my sleep. The night before visiting his parents, not the best night’s sleep. Have to tell somebody something, could it be affecting my sleep. Never sleep in, even at weekends.’
Allen T.F. (1990) Encyclopedia of Pure Materia Medica B. Jain India
Boericke W. (1987) Materia Medica with Repertory Homeopathic Publications, India
International Foundation for Homeopathy (1995) Small remedies and interesting cases VII Proceedings of the 1995 Professional Case Conference – A series of Ambra grisea cases, Michael Thompson p341- 387 IHF USA
Johnston L. (1996) Homoeopathic Links I can’t take any more. Two different aspects of Ambra grisea Volume 9 Autumn 1996 p 134- 138 and I can’t take any more Ambra grisea, part II Volume 9 Winter 1996 p 189-192 Netherlands
Kent J. (1987) Lectures on Homeopathic Materia medica Homeopathic Publications India
Morrison R. (2007) Ambra grisea sound clip Radar 9.1 Archibel Belgium
F Schroyens Synthesis 9.1 Archibel
Thompson M. (1996) Ambra grisea the road to homoeopathic practice vol.1 Doghaus Publications UK
Vithoulkas G. (1995) Materia Medica Viva Volume 1 Homoeopathic Book Publishers London