Case of a 48 year old man with Diabetes Mellitus with history of injury (rat bite) and hypertension first seen on 25th July 2015.
Case of diabetes mellitus since 10-12 years
Came with complaint of rat bite in right forearm and right dorsal part of hand. Complaints are since 40-50 days. Along the site of injury, pains on slightest touch+++ and swelling++
Patient was on Augmentin 625 for more than month with no relief and on antidiabetic and antihypertensive medicine. Patient was Rx’s insulin 20 units morning and evening and 15 units during afternoon
Blood Sugar (13th July 2015)
- Fasting: 291
- Postprandial: 412 Urine Sugar +++
PATIENT AS A PERSON
Appearance: Thin, dark complexion with grey and dry hair. Patient has addiction of alcohol. No abnormalities were observed in nails and face. Can’t bear tight/fitting clothes, feels uncomfortable+
Mouth: offensive breath
Appetite: Good (Vegetarian)
Craving: Alcohol+++ (especially whisky), spices++
Aversion: Nothing specific
Thirst: 4 litres /day (approximately) for plain water; drink 2-3 glass at a time.
Elimination Stool: Normal Urine: Normal
Perspiration: Profuse on face+++, staining clothes
Sleep: 7-8 hours…refreshing; Sleeps on back
- Pulse: 89/ min
- Blood Pressure: 140/90 mm hg
- Temperature: Afebrile
- No clubbing, no cyanosis, no pallor
- The wound area was painful++, and was sensitive to touch, pain on slightest touch. No
- Respiratory system: Normal
- V.S: S1S2 Heard
- N.S: NAD
|Paternal Grandfather||Doesn’t remember|
|Paternal Grandmother||Doesn’t remember|
|Maternal Grandfather||Diabetes mellitus|
|Maternal Grandmother||Had Head Injury → Haemorrhagic Stroke → Death|
|Father||Died due Myocardial Infarct|
|Mother||Diabetes Mellitus, Osteoarthritis of Knees|
|Uncle (Father Side)||Diabetes Mellitus|
|Uncle (Mother Side)||Diabetes Mellitus, Hypertension|
|Elder Sister||Hypothyroid, Fibroid in Uterus|
|Jaundice||2004||Allopathic Drugs||Fully Recovered in 30-40 Days|
Patient was born in Madhya Pradesh; his family moved to Mumbai when he was two. His education has been done in Mumbai. Patient is qualified till 12th standard, and has left study because of financial problem, and also patient was not interested.
He started earning money by working in jewellery shop. After 15-20 years he bought his own jewellery shop. There is great fear of failure; he wanted to make his business very big. He started gambling in order to make more money, because he wanted to buy a big shop. Within few months he lost his shop and all his money, because of powerful people. The people even threatened to kill him.
After the loss of his shop and money, now he is working in a stationary shop. He now sleeps on footpath; his meals are also not very regular. His mother stays at the house of the person in whose shop he is working. His mother works as a servant
He gets confused easily while making decisions. Confidence level very poor. Gets very angry+++ if someone contradicts him. Cannot stay alone++, needs company. Difficulty in remembering the names of places++
On observation it was seen that patient used to take long time to answer or used to forget some words while giving history.
Greatest grief was his father’s death (weeping). Father died very early and he still feels sad about it.
- A well-defined characteristic picture of remedy, especially at level of mind and generals → indicates a high level of susceptibility and therefore calls for the simillimum in high potency. (Dr. M.L. Dhawale)
- The closer the similarity a remedy bears to the picture presented by the patient, the higher is the potency, provided no specific contra- indications to the use of high potencies exit in the case. (Dr. M.L. Dhawale)
- Predominantly mental and general symptoms → High potency
- The action of a remedy is known to exhaust early; therefore, frequent repetitions are indicated. As the response is obtained, the frequency is cut down progressively so that the dose tapers gradually. Premature cessation of the remedy is known to promote a
Selection of Repertory:
This case has good mentals & generals, hence Kent Repertorial approach has been selected.
Software: Radar Opus 1.43
- MIND – AILMENTS FROM – grief: (96)
- MIND – AMBITION – increased – money; to make: (6)
- MIND – COMPANY – desire for: (190)
- MIND – CONTRADICTION – intolerant of contradiction: (129)
- MIND – FEAR – failure, of: (129)
- MIND – FORGETFUL – streets, of well-known: (11)
- MIND – FORGETFUL – words while speaking; of: (93)
- MIND – GAMBLING – passion for gambling: (19)
- MIND – GAMBLING – passion for gambling – make money; to: (10)
- MIND – IRRESOLUTION: (234)
- MIND – MEMORY – weakness of memory – places, for: (16)
- MIND – MEMORY – weakness of memory – words; for: (86)
- MIND – OBSTINATE: (158)
- FACE – PERSPIRATION: (195)
- MOUTH – ODOR – offensive: (213)
- SLEEP – POSITION – back; on: (95)
- DREAMS – FRIGHTFUL: (251)
- PERSPIRATION – STAINING the linen: (67)
- GENERALS – CLOTHING – intolerance of: (71)
- GENERALS – DIABETES MELLITUS: (195)
- GENERALS – FOOD and DRINKS – alcoholic drinks – desire: (244)
- GENERALS – FOOD and DRINKS – sweets – desire: (284)
- GENERALS – WOUNDS – bites: (92)
After repertorization the remedies which were coming up were Lycopodium, Crotalus Horridus, Lachesis, and Secale Cornutum.
Lycopodium: lycopodium is not a known remedy for insect bite, rodent bite, etc. Ulcers: bleed and burn when dressed; tearing and itching at night, burning when touched; fistulous, with hard, red, shining, everted edges, and inflammatory swelling of the affected parts; bleeding easily.
Crotalus Horridus: The only symptoms that contraindicated Crotalus Horridus was hemorrhage which was not seen in the patient. Oedema about the affected part (seen in patient). Great sensitiveness of skin. Dissecting wounds. Insect stings. Ulcers with bluish purple surroundings is not so marked in Crotalus Horridus, it’s more prominent Lachesis.
Lachesis: Ulcers with bluish purple surroundings (which is not seen in patient). One more symptom which is very marked in the patient and is not found in Lachesis is: memory weakness for place, he forgets the name of place and has fear of failure.
Secale Cornutum: In Secale Cor there is dry gangrene with lot of burning and parts are cold to touch (which was not seen in patient). Wants part to be uncovered. Skin feels cold to touch, yet covering is not tolerated. Great aversion to heat. Formication under skin. there are lot of maniacal and depressive symptoms in Secale Cor which comes from the toxicological effect. The mental picture of patient is not covered by Secale Cor.
FOLLOW UP (10-08-2015)
|Pain in the arm reduced considerably by 70-80%|
Swelling of forearm is not seen Sensitivity to touch is not seen Overall feeling good
Energy level is good No tired feeling
Now gets sound sleep, no dreams Blood Pressure: 130/80mmHg
Patient was advice for blood and urine sugar for next follow up
CROTALUS HORRIDUS 1M 4 DROPS BD
6 PILLS OD
FOR 15 DAYS
Kent’s 4th Observation: No aggravation what so ever with recovery of the patient.
When the patient starts feeling better and his complaints are relieved immediately after the remedy is given, it’s simple amelioration and this type of reaction could be said to be an ideal type of response. This is rarely attainable and indicates a fortuitous circumstance where functional changes only are present and patient has received the simillimum in correct potency and dose.
FOLLOW UP (29-08-2015)
|Blood Sugar (26-08-2015)|
· Fasting: 110
· Postprandial: 190 Urine sugar: —
Pain in the arm – o – Swelling of forearm – o –
Sensitivity to touch is not there Overall feeling much better Energy level increased
Blood Pressure: 140/90mmHg Dreams of travelling
CROTALUS HORRIDUS 1M 4 DROPS OD
6 PILLS OD
FOR 15 DAYS
Patient was on Crotalus Horridus 1M for 1 month.
After that after he was put on Lycopodium 30C latter to 200C. Patient is doing very well with Lycopodium 200C, in all aspects. After starting lycopodium 200C his mouth odor started reducing. His blood sugar and hypertension is under control.
His anger has reduced, he has become much calmer. His energy level improved.
Now no frightful dreams, occasionally gets dreams which he doesn’t remember.
Whenever Crotalus horridus works in an acute situation, then Lycopodium complements its action. (Dr. Farokh J Master: Snake to Similimum)
- Hering (The Guiding Symptoms of our Materia Medica – Volume 4; 7th impression 2010; B. Jain Publisher; Page Number: 484 to 512)
- Farokh J. Master (Snake To Similimum, Demystifying Venom; Foreward by Dr. Frederik Schroyens; Published by B. Jain Archibel s.p.r.l)
- M.L. Dhawale (Principles & Practice of Homoeopathy; Fifth Reprint Edition 2008; Published By Dr. M.L. Dhawale Memorial Trust)
- Herbert A Robert (The Principles & Art of Cure by Homoeopathy; 3rd
edition; B. Jain Publishers; chapter-Homoeopathy & the Fundamental Laws; page numbers: 53,54)
- J T Kent (Repertory of the Homoeopathic Materia Medica; edition; B. Jain Publishers)
- Samuel Hahnemann (Organon of Medicine; translated with preface- William Boericke; 6th edition; Indian Books & Periodicals Publishers)
- Software: RadarOpus 43