This 6-year-old boy first developed recurrent bronchitis at the age of 1.5 years. He used to get bronchitis 3 or 4 times over the course of winter. They only used Ventolin, because he was refusing to swallow any antibiotics. He was diagnosed with asthma when he was 3 years old. They give him Flixotide and Seretide inhalers daily and prednisone during acute stages.
Each asthma attack is preceded by developing dark circles under his eyes. (3) Then he starts being nervous and gets watery coryza. (2) After that, his breathing gets difficult, he develops a cough and starts being tired. (2-3) Respiration and cough are a bit better in the open air.(1) The attacks tend to come at around 10-11 p.m., before midnight.(2) He sits up in bed, sways to and fro and cries.(2)
His attacks mainly occur in autumn and winter and on the turn of autumn/winter and winter/spring. He is free of complaints in summer.
I observe that the boy very restless.(3) His mother confirms it and adds that he has excessive energy and it is impossible to make him tired.(4) His sleep is very restless (3). He sometimes even falls off the bed. He is very curious, constantly asking questions.
He has aversion to cabbage and lettuce. (2) He craves pasta and rice.(1-2)
He drinks little (2), but his mother says it may be explained by him being too occupied with other activities and simply forgetting about it.
He gets angry when he fails at doing something, but he does not want to be helped.(2) He wants to solve obstacles on his own.(2) He used to get more angry when he was smaller, but they purposely worked on it and it got better. When he gets angry, he stamps his feet, hits or kicks things.(2) This has also gotten better in the past 2 years though.
He is fearless and quite heedless, climbs up trees and tries any kind of challenge.(2) However, he is afraid of the dark (3) and of looking at his own blood (2). He has brittle fingernails and deformed toenails.(2) He has always sucked his thumbs. Now he does it less frequently, but it is still there.(2) He has dry skin.(2)
He is adopted and was born prematurely. We do not have any information regarding his family medical history, apart from that his biological mother was probably a drug addict.
He currently does not get fevers. He only has asthma attacks without fevers or with low-grade fevers. He had a fever of 39° C once in the past with bronchitis.
Analysis of the case:
Pathology in this case is distributed on the physical and mental level. The fact that the boy does not get high fevers anymore is not favourable for the prognosis and it shows that the overall vitality of the organism is low. This is a common phenomenon in asthma cases.
In many of them, the development of asthma is preceded by recurrent respiratory infections (most often bronchitis) which transform into a chronic inflammation later on. Sometimes there is a sub-acute phase in-between. The transformation into chronic inflammation happens especially when the acute respiratory infections are suppressed by repeated doses of antibiotics or corticosteroids.
Ventolin is not a corticosteroid, but can have some suppressive properties too, I believe, although not as strong as steroids or antibiotics. The asthma (chronic inflammation) develops when the organism gets weaker and it is not able to produce acute and intense immune responses anymore (e.g. acute bronchitis).
We do not have any information regarding the family medical history. There is only an assumption that the boy’s mother was addicted to drugs. If that is true, it makes the prognosis worse, because addicted people often have serious mental pathology.
We know from experience that asthma can be cured with homeopathy and considering all other factors, so the prognosis is quite positive
Selection of symptoms:
- Dark circles under eyes before an asthma attack (3)
- Asthmatic respiration better in open air (1)
- Asthmatic attacks at 10 or 11 p.m. or before midnight (2)
- Asthma worse on the verge of autumn/winter and winter/spring (2)
- Sucks his thumbs (2)
- Wants to solve problems on his own (2)
- Fearless and heedless (2)
- Restlessness (3)
- Excessive energy (4)
- Restless sleep (3)
- Fear of the dark (3)
- Fear of looking at his own blood (2)
- Angry when is not successful at doing something with stamping feet, hitting or kicking things.(2)
- Brittle fingernails (2)
- Deformed toenails (2)
- Dry skin (2)
Food preferences in this case are not really peculiar for a small child, so I do not include them in the analysis. I included two symptoms which are less prominent than they used to be, however, they are still present. One of them is sucking of thumbs which I consider peculiar for the boy‘s age, and the other is the anger with violence and destructiveness, which may have improved only because they purposely led the boy to change his behaviour and it is still quite strong anyway. Lack of thirst may be explicable by his restlessness and paying attention to other things. I do not consider curiosity a pathology unless it is really excessive, so I did not include that in the analysis either.
Relevant rubrics: (using The Essential Synthesis repertory)
FACE – DISCOLORATION – bluish – Eyes – Around; circles
FACE – DISCOLORATION – dark – Eyes; circles under
RESPIRATION – ASTHMATIC – air; in open – amel.
RESPIRATION – DIFFICULT – air; in open – amel.
RESPIRATION – ASTHMATIC – night – midnight – before – 22 h
RESPIRATION – ASTHMATIC – night – midnight – before – 23 h – 23-2 h
RESPIRATION – DIFFICULT – night – midnight – before – 22 h
RESPIRATION – DIFFICULT – night – midnight – before – 23 h
RESPIRATION – DIFFICULT – night – midnight – before
RESPIRATION – ASTHMATIC – winter attacks
RESPIRATION – ASTHMATIC – weather – cold – wet – agg.
RESPIRATION – ASTHMATIC – accompanied by – coryza
MIND – DESTRUCTIVENESS
MIND – GESTURES, makes – fingers – mouth; children put fingers into the
MIND – FEARLESS
MIND – RESTLESSNESS
GENERALS – RESTLESSNESS
GENERALS – ENERGY – excess of energy – children; in
SLEEP – RESTLESS
SLEEP – POSITION – changed frequently
MIND – FEAR – dark; of
MIND – FRIGHTENED easily – blood, at sight of
MIND – BLOOD; cannot look at
GENERALS – FAINTNESS – blood, at sight of
MIND – GESTURES, makes – feet; involuntary motions of the – stamping the feet
MIND – STRIKING
MIND – KICKING
HEAD – PAIN – Temples – right
EXTREMITIES – NAILS; complaints of – brittle nails – Fingernails
EXTREMITIES – NAILS; complaints of – distorted nails – Toenails
SKIN – DRY
RESPIRATION – ASTHMATIC – children; in
Differential diagnosis of the most probable remedies:
Tuberculinum is a very restless remedy. It has restless sleep. It has asthmatic respiration better in the open air (although mainly when going against the wind or driving with an open window). This symptom, however, is not strong in this case. It also covers destructiveness during anger with striking and kicking.
Veratrum album is one of the most restless remedies in our Materia medica. It covers asthmatic respiration worse in cold wet weather. Restlessness is the only keynote of the remedy in the case and it cannot be confirmed otherwise.
Medorrhinum is one of the main remedies for asthma occurring at early age in children. Although it is not considered a keynote, Medorrhinum children can be very restless, but more importantly, they are full of energy. It is a remedy of extremes and the energy can also be very extreme. The remedy has general aggravation in wet weather (sycosis) which could correspond with the aggravation of the patient’s asthma at the transition between autumn and winter or winter and spring. These tend to be the wettest parts of the year (at least here in Europe). Asthma worse in wet weather is a typical sycotic trait. Medorrhinum has a strong fear of dark and we can also confirm sucking fingers in children and brittle fingernails. Medorrihum children can have strong behavioural problems including anger with aggression, kicking, striking and destructiveness.
Stramonium has fear of the dark as a keynote. It is a violent remedy and it covers destructiveness and aggressiveness during anger. Stramonium can be very restless and can have excessive energy. It is suitable for children with behavioural problems. It covers asthma, but mainly spasmodic type of asthma.
Tarentula is one of the most restless remedies and covers violent and destructive behaviour. It does not cover asthma though.
Rhus toxicodendron has restlessness as a keynote and there is an addition in the repertory1 of this remedy in the rubrics Respiration – Asthmatic – Air; In Open – Amel. And Respiration – Difficult – air; in open – amel. from Frederika E. Gladwin (a student of J.T. Kent).
Arsenicum iodatum can be found in the rubric Respiration In the rubric Respiration – Asthmatic – accompanied by – coryza. It is a very restless remedy with a lot of energy and likes to be in the open air. It has asthma aggravated before midnight, particularly between 11 p.m. to 2 a.m. It is the only remedy in the rubric Respiration – Asthmatic – night – midnight – before – 23 h – 23-2 h. It has watery coryza. It could be a good option during his acute episodes (as well as Arsenicum album).
Carcinosin is one of the main remedies for asthma beginning at young age and it covers restlessness. Anger with destructiveness is typical for the second type of Carcinosin, which occurs very rarely though.
None of the remedies which are known to cover the fear of looking at blood (Calc, Aloe, Alum, Nux-m) can really be confirmed in this case. But as the boy cannot stand the sight of only his own blood and it is not so peculiar in children anyway, I do not consider this symptom so important.
Selection of the remedy:
The three main candidates for the similimum in this case in my opinion are Tuberculinum, Medorrhinum and Arsenicum iodatum. I excluded Arsenicum iodatum as it does not cover some important aspects of the case like fear of the dark or anger with violence, but it might be needed during an acute asthma attack.
Although Tuberculinum is a more restless remedy than Medorrhinum, or we should rather say that for Tuberculinum it is a better confirmed symptom, I prefer Medorrhinum, which can still be very restless and has excessive energy, but it also covers fear of the dark (it is better confirmed in Medorrhinum than in Tuberculinum), sucking fingers and brittle fingernails (the addition for this symptom in the repertory is from Prof. Vithoulkas). Medorrhinum has been very well confirmed for asthma in young children which corresponds to its sycotic miasm. That is another reason to prefer this remedy.
Prescription: Medorrhinum 30C once a day until a reaction
Note: I chose daily dosing in a lower potency because the boy is taking allopathic medication daily.
Outcome of the treatment:
Follow up 1: 2 weeks of taking the remedy
The parents should have contacted me earlier as there was a reaction during the first week already, but they misunderstood my advice of giving the remedy for 2 weeks maximum and kept dosing for the whole 2 weeks. In cases under allopathic drugs, I usually recommend dosing only until there is a reaction (clear aggravation or amelioration) and if there is no reaction in 2 or 3 weeks, I change the remedy. From my experience, the reaction in such cases usually emerges within the first week of dosing.
During the first week, the boy has started being hungrier, which still persists. Dryness of skin got worse for a few days and then it got better. He has been easier to deal with and more obedient. He wants to be kissed and hugged a lot.
In the beginning of the second week, he developed a mild coryza but there was no cough or breathing problems this time, which is unusual for him.
Evaluation of the reaction:
There have been signs of mild aggravation, but we can already see some improvement in his behaviour and the appearance of coryza without respiratory symptoms.
The parents might have contacted me during the first week already, but at the same time, I do not think they did any harm by doing it one week later.
Recommendation: withdraw Medorrhinum and wait
Follow up 2: 1 week after the first follow-up (3 weeks from the beginning of the treatment)
The boy finally developed asthmatic cough from his coryza. The cough is worse from lying in bed in the evening and in the morning after waking.(3) It is better from drinking (2) and in the open air (3). He craves cold drinks (2), but drinks little, as in his chronic state. The cough is dry and deep (3) and is worse from deep inspiration (3) and eating (2). He wants physical contact, wants to be cuddled and he is weepy.(3) He has no fever.
The asthma attack needs to be treated. The picture is not clear, but there are quite a few symptoms of Pulsatilla so I opted for this remedy.
Prescription: Pulsatilla 30C, 2 doses
Reaction to the remedy:
After Pulsatilla, the boy developed a fever 38.2°C which lasted a few hours and then the whole asthma attack subsided. He was completely free from symptoms within 24 hours.
Follow up 3: 5 months after beginning of the treatment
He has not had any asthma attack since the last one we treated with Pulsatilla. For the past 3 months, they have not been giving him any medication whatsoever. They withdrew all inhalers completely.
They have just been at the allergology ambulance for a check-up and the doctor found significant improvement in his breathing. She has said that the asthma has been on a decline and there is a chance that it will go away completely. She did not prescribe any medication for him.
He is a bit less restless. He is able to concentrate longer. His sleep is also calmer. He is easier to deal with and less angry. He started eating green vegetables like seaweed.
Evaluation of the reaction:
There has been a clear improvement not only in the boys asthma, but also in his behaviour, restlessness and concentration.
It is a question to what extent Pulsatilla has contributed to the improvement, but a correctly prescribed remedy for an acute condition may sometimes have positive influence on chronic condition too, especially if the “acute” remedy covers some symptoms of the chronic picture. In this case, we have the asthma better in the open air, lack of thirst and fear of the dark as chronic symptoms, which belong to Pulsatilla.
However, the improvement of his restlessness and difficult behaviour cannot be attributed to Pulsatilla so we can assume Medorrhinum was the correct remedy. In cases of asthma, it is common that we have to deal with one or more asthma attacks before we bring the organism to a stable condition.
Follow up 4: 7 months after beginning of the treatment
One month ago, the boy had a coryza with mild cough which lasted only 3 days and he did not have any respiratory problems with it. It subsided on its own. There have been no respiratory complaints otherwise. He is not taking any medication. His behaviour has improved a great deal. He is much less defiant, less angry and more obedient. Restless has improved. Sleep is still quite restless, but it is also better than before treatment.
He sometimes gets tired. This did not happen before treatment and it means his energy is not so extreme anymore. Fear of dark has improved. Sucking of thumbs has improved. His thirst is still low.(2) He has had aversion to meat and fish recently.(1)
I found out that he bites his nails a lot (3). He had this symptom before treatment already, but the mother did not mention it. It has not improved after treatment. He had epistaxis last week, for the fourth time during the past year. His feet sometimes perspire.(1)
Evaluation of the follow-up:
The positive progress of the case continues. The boy has improved in many areas, both physically and psychologically. It is interesting that I have discovered a symptom which the boy already had before treatment and which confirms the selection of the remedy. Biting of nails is a big keynote of Medorrhinum.
There are some new symptoms like aversion to meat and fish or perspiration of feet, but these symptoms are not strong and it is definitely too soon to think about the next remedy the boy may need in the future. It is interesting that Medorrhinum has desire for meat and fish. I have noticed that sometimes a homeopathic remedy may flip a polarity in food desires or aversions. If it covers some desire for certain food, it sometimes produces an aversion to it and when it covers some aversion to a certain foodstuff, it may cause a desire for it after its administration.
Follow up 4: 4 days after the last follow-up
The boy has developed an asthma attack. It started last night at around 1 a.m. He is very cuddly again.(3) He has mild coryza, a cough and difficult respiration.(2) There are no other symptoms or modalities.
Prescription: Pulsatilla 30C, 2 doses
Follow up 5: 2 months after the last follow-up (9 months after beginning of the treatment)
After Pulsatilla, the asthma attack subsided in a few hours, just like the last time when we gave this remedy. We have not given any other remedy since then. Now he has had a cough for 3 days. It has been getting worse. It is an irritating deep cough.(3) It woke him up at 5 a.m., but he has been coughing the whole day. He tends to sit up in bed and bend forward during the cough.(2) He is trying to get his head high when lying in bed.(2)
His face is a bit swollen and he has swollen eyelids and cheeks.(2) He has the dark circles under eyes again.(2) There is no fever. He has a bit of coryza (1) which is watery (3). He has had dry skin over the past week.
Prescription: Kali carbonicum 30C
Reaction to the remedy 6 hours later:
There has been no change after Kali carbonicum. There is a possibility of Arsenicum album, but as the picture is not clear and they cannot get this remedy quickly, I opt to try Medorrhinum first as the boy’s chronic remedy.
Prescription: Medorrhinum 30C
Reaction to the remedy:
The boy got Medorrhinum in one dose in the evening during a strong cough attack and the cough already improved the same evening. Next morning the cough was even better and he asked for food. The coryza got thicker.
The cough completely subsided over next night and the coryza went away in another 3 days. The mother said that this was not an asthma attack as he did not have difficulty breathing. When he had such a cough before treatment it always ended up in an asthma attack.
Follow up 6: 3 months after the last follow up (1 year after beginning of the treatment)
The boy has been well up to now, but he has now developed an asthma attack. It is the strongest attack since the beginning of our treatment. It is as bad as the attacks before treatment. He woke up at night with dyspnoea, but not so much cough. They had to give him prednisone. Now he is better but not really well. Before the attack he had experienced a kind of bullying at school where his schoolmates were laughing at him.
Evaluation of the follow-up:
The fact that the boy has developed a very strong asthma attack after a long time means that there has probably been a relapse. There are no specific symptoms, so the only option is to repeat the chronic remedy Medorrhinum. I would prefer raising the potency at this point, but as they did not have 200C at home, we had to give 30C again.
Prescription: Medorrhinum 30C
Reaction to the remedy (next day):
The difficult respiration has improved after Medorrhinum, but he has developed a cough. The cough started in the morning and he has been coughing up till now (afternoon). It is dry tickling (3) paroxysmal cough (3) and he coughs in a quick succession (3). It is so quick that he sometimes cannot catch his breath.(2) The paroxysms follow one after the other quite quickly (about every 5 minutes).
He has red face during coughing.(2-3) The cough is also worse by eating and motion.(2) At this point, he is already better as breathing improved and the pathology transformed itself into the cough. As I saw a quite clear remedy picture, I decided to prescribe another remedy, which was Drosera.
There is also a possibility of Ipecacuanha and Coralium rubrum, but I prefer Drosera because it covers cough worse from eating better.
Prescription: Drosera 30C
Follow up 7: 2.5 months after the last follow-up (14.5 months after beginning of the treatment)
The boy only took 1 dose of the remedy and improved quickly after it. The cough disappeared completely in about 2 days. He has not had any other asthma attack since then and has not been taking any chemical drugs in the long term for about one year.
One month ago, they went to the allergology ambulance again and the test results showed absolutely normal findings. The allergologist said that if the results are so good next time too, she will discharge the boy from register and officially end his treatment.
Dryness of his skin got worse again.2 He is still quite energetic (2), but is able to concentrate on things better. His sleep is calmer. Anger remains better. He is competitive.(3) When he loses, he does not want to play more.
He has developed an aversion to slimy food.(2) He has become more thirsty.(2) He is not so afraid of looking at his own blood anymore. Fear of the dark has been better. He still bites his nails.(3) The fingernails are still split in the end, but they do not know how the biting of nails contributes to that. His toenails are still deformed.(2) He has become more open, communicative and nicer to people. He used to be introverted before treatment.
Evaluation of the follow-up:
The asthma has clearly been better and we have a confirmation for that from a medical specialist. As I mentioned earlier, there might have been a relapse, but the remedies prescribed for his last asthma attack seem to have taken care of that.
In the current situation I do not see a reason for any intervention and I suggest waiting. It is interesting that he has developed a new symptom belonging to Medorrhinum, aversion to slimy food. Most probably it is proving of the remedy, but it might also be a symptom of the next remedy the boy will need.
The fact that he used to be introverted before the treatment is another confirmatory for Medorrhinum which I would have been happy to know before treatment. Another interesting point is that his fear of sight of his own blood has improved, although we do not have this symptom recorded for Medorrhinum.
I have seen quite a few cases in which a remedy has cured symptom(s) which are not recorded for the remedy yet. This is possible, because our remedies do not treat symptoms, but the whole organism. If the remedy is close enough, it will shift the overall vitality of the patient and the defence mechanism will take care of the rest including some symptoms which do not belong to the given remedy.
There is a foundation for registering new symptoms that we noticed to have disappeared after a certain remedy for which they have not been recorded previously, so I would like to encourage fellow homeopaths to submit their observations there. The foundation is called Archive for homeopathy and the website is http://www.archiveforhomeopathy.com/
Follow up 8: 6 months after the last follow-up (20 months after beginning of the treatment)
The boy has not had any asthma attack and has not taken any chemical drugs. He only had a simple mild cough about 2 months ago after bathing in a pool. Last week, he had a mild coryza. The allergologist finally discharged the boy from her treatment and pronounced him completely cured.
Dryness of skin has improved. He still bites his nails (3), but they have become stronger. Quality of his toenails has improved too. Restlessness is much better. Restlessness in sleep is also better, but still remains to a certain degree. He has improved a lot at school. He is able to concentrate better and has better marks. Teachers praise him.
He is much easier to deal with. He does not have any significant complaints at the moment.
It is always nice to see the results of treatment confirmed by objective diagnostic tests. It is interesting that we have not needed to raise the potency of the original remedy so far. This will probably be inevitable in the future, so I advised the parents to order Medorrhinum 200C and keep it at home.
Medorrhinum might be the boy’s constitutional remedy, but there is also a possibility that he will need another remedy in the future because there are some new symptoms emerging.