At the onset of winter a 10 year old girl came with complaints of respiratory problems for the last eight days. Difficulty in breathing and feels suffocation at throat, > outdoor, < laughing. Loose cough with difficult dark yellow expectoration. Cough wakes her from sleep at 3am, > by lying with head high. Distressing and exhausting cough, > cold drinks. Thirst for small quantities.
The last few days her nose has been congested in the morning. Everything started after the sudden accidental death of a pet dog (she wept). She fears her father who is known for his reprimanding nature. She complained of being left alone by classmates in school because she got lower grades.
Her teacher even asked her elder sister why she was not able to score better marks like the elder sister. Her aunt tells her not to play in the sun since she has a tanned skin in comparison to her elder sister. Another aunt asks her why she is not as bright as ger sister? Her uncle calls her ‘Suklo bombil’ (Bombay duck fish) because she is thin and emaciated.
Loss of appetite
Throat- No enlarged tonsils, Congestion +
Neck- Lymph nodes not palpable
R.S- Wheeze +
Observation– The girl was talkative and sounded hoarse. She sought attention by interrupting her mother’s conversation, but not rudely. Her mother said that she is very caring about others.
Clinical Diagnosis: Acute episode of bronchial asthma
Formulation of Acute Totality:
Ailments from sudden bad news
Ailments from repeated insults
Cough > cold drinks
Cough < laughing
Cough > outdoor
It was unclear whether she is really aggravated by cold things like ice cream since cold drinks did not bother her.
* Mucus coughed up in the morning is covered by Hydrastis and Hepar-
- Cuprum cough is after midnight
- Stannum cough is before midnight
- Rumex cough is dry, tickling, beginning from throat
- Allium cepa cough is due to tickling at the back of the palate and ptient will sneeze and cough as a result
- Bryonia Alba cough is superficial, more dry feeling and wants to hold her chest, as with every cough their rib cage expands and it hurts.
- Phosphorus cough is worse mornings and evenings, accompanied by painless hoarseness, worse when strangers enter the room. Since it has affinity for left lower lung the patient is worse lying on the left side.
- Pulsatilla cough appears in the morning, <mental effort and better by dry weather.
- Causticum cough is deep hacking cough with feeling that she cannot cough out the mucus. Cough < night, while lying down and has to sit up. As if something stuck in throat doesn’t come out. > drinking
Diagnosis of Remedy: Considering the sympathetic nature of this child who had gone through repeated sorrows and the particulars of the cough, the remedy selected was Causticum. Causticum is vulnerable, the initial state of over reactivity becomes turned inward. It is as if they are cramping her inwards (bronchospasm). They are upset, angry and want to do something about it. They take up a cause.
- First Prescription dated 18-Nov-2019 was Causticum 200, 1 single dose consisting of 3 pills, P.l for 20 days B.D
- 21-11-2019 Mother telephoned to say her daughter is coughing more compared to before. However, she is able to expectorate each time. I told her not to fear the intensification of cough since it was necessary in order to expel the mucus.
- 23-11-2019 Mother sent watsapp message that the girl is better
- 24-11-2019 Received message that she had recovered completely.
- 08-02-2020 Child is well with no asthma episodes.
The whole strategy about case-taking is that you have to understand the person, not just her complaints.