A Case of Herpes Simplex Virus – Type 1 and Generalized Anxiety Disorder

Introduction:

Ms. P. Shah, 32 year old unmarried female, had complaints of recurrent mouth blisters, more on the inner side of lower lip and cheeks. The blisters were extremely painful. Hence she visited her family physician for treatment. After doing a viral culture, she was diagnosed with Herpes Simplex type 1 and put on anti viral drugs.

By the time she visited me, she was well read about the disease. Her concern was that despite being a self limiting disease, the blisters kept recurring. She became very anxious about it and hence decided to consult me for a different mode of treatment.

About Herpes Simplex Viral disease (type 1) 

Herpes Simplex Virus-type1 is a self limiting, but not a curable disease. It is said so because once the patient is infected with the virus, it remains latent and hiding in the immune system in the cell bodies of the neurons. After the initial or primary infection, some infected people experience sporadic episodes of viral reactivation or outbreaks. Usually the attack can be brought on by:

• General illnesses
• Fatigue
• Physical and mental exertion

It is usually transmitted by direct contact with body fluids or lesions of an infected individual. Conventional treatment usually involves general-purpose antiviral drugs that interfere with viral replication, reduce the physical severity of outbreak-associated lesions, and lower the chances of transmission to others.

Chief Complaints:

The patient complained mainly of repeated outbreaks of blisters in the mouth, which were extremely painful and at times filled with a yellowish clear fluid. Due to the pain and burning in the mouth, she was unable to eat properly. After the antiviral medicines, she was better only for a few days. But the outbreak of these blisters occurred repeatedly. At times she would also feel feverish with the outbreak.

Associated Complaints:

Along with the complaints of recurring mouth blisters she also had severe anxiety issues. She had a habit of excessive lip and nail biting, both confirming her anxious nature. Her lips were almost chapped when I first saw her. She spoke of having   palpitations when there was too much stress at work. She also suffered from:

• Severe dysmenorrhoea and backache during menses
• Lot of mood swings before menses
• Leucorrhoea before menses
• Chronic cervical pain which got aggravated with mental exertion

Observations:

• Noticeable premature graying of hair
• Chapped lips
• Over analyzing every small symptom

Past History: Nothing significant

Family History:

• Father underwent a CABG (Coronary Artery Bypass Grafting)
• Mother- nothing significant
• Paternal side had a history of cardiac illnesses

Generals:

• Appetite: Good, but no specific cravings or aversions
• Thirst: 8- 10 glasses a day
• Stool: N.C.
• Urine: N.C.
• Perspiration: More in the axilla
• Sleep: Sleeplessness due to excessive thoughts
• Thermal: Chilly patient

Personality Traits:

• She is a very hurried person in general. Wants to do everything quickly not only out of habit, but is also quite impatient.
• The smallest things make her exceedingly anxious. Even if she is late to reach a destination, she gets palpitations.
  • She says, “I keep thinking about everything and most of the times only the negative aspect. I have a constant fear that something bad will happen; something will go wrong in life”.
• Patient is very anxious about her illness.
  • She says, “I am worried about this disease since I will have to tell my partner about it, whenever I meet someone for arranged marriage”.
• Patient is happier when not in company and also finds it difficult to communicate with new people.
• She is very particular about cleanliness and thinks she has OCD.

Life Situation:

• Born and brought up in a poor family with two siblings, there were always financial problems at home.
• She spoke of her life as “I could not have too many things in my childhood and hence always knew I had to work very hard to have a better future. I have been very responsible since then. Took care of my younger siblings and started working very early in life to earn some money and be independent”.
• She constantly has a feeling of life being unfair to her, especially when she compares herself to her friends. Even when she got a job she was not paid as well as her colleagues. It bothered her a lot. She switched jobs and currently was also under a lot of work pressure.
• She is worried about her being unmarried at this age. She over-thinks and broods about her past even today.
• She is emotionally very sensitive, cries easily and has at times had suicidal thoughts. This has led to very low self confidence in her.
  • She says, “I am always discontented in life and constantly thinking about my future. I also get panic attacks at times. I know my health deteriorates when I am too stressed”.
  • She further adds, “My sleep is disturbed by these thoughts. I feel I never get sound sleep and am always awake”.

Analysis:

After a detailed case taking, it was evident that there were a lot of mental factors aggravating the bodily symptoms, and we could term this a psychosomatic disease. Whenever she would be stressed, be it at home or at work, the blisters in the mouth would erupt and would be extremely painful. Her lip biting was clear evidence of her underlying anxiety. Panic attacks and sleeplessness occurred too often and deteriorated her health further.

On the basis of this, I decided to give her a constitutional medicine which would not only help with the attacks of herpes simplex virus but also would help her deal with anxiety. The totality comprised more characteristic mind symptoms rather than physical generals since none were too marked in the patient.

Prescribing Totality: (in form of rubrics)

• Mind – Ambition increased
• Mind – Industrious
• Mind – Brooding, dwell- past disagreeable occurrences on
• Mind – Anxiety about health (one’s own) and future
• Mind – Confidence, want of confidence
• Mind – Discontented, everything with
• Mind – Responsibility-taking responsibility too seriously
• Generals – Uncleanliness aggravates
• Generals – Heat-lack of vital heat

Remedy prescribed:

Aurum Muriaticum Natronatum 30 – 4 drops twice a day for 15 days

Follow up:

Date	Follow up	Treatment
15-12-14	Ulcers much better. No new ones have come up Cervical pain > Feels calmer but still struggles to fall asleep. Lip biting –SQ-	Aur Mur Nat 30 4 drops 3 times a day x 15 days
Next 3 follow ups	Menses less painful but ulcers came up once when she changed her job Anxiety > She sleeps better	Aur Mur Nat 200 4 drops twice a day x 1 month
Next 3 follow ups	No outbreaks of any mouth blisters No lip biting Feels better in general	Aur Mur Nat 200 4 drops twice a day x 1 month
After 3 months	No new mouth blisters Sleep-improved Cervical pain > Feels more confident now	Aur Mur Nat 200 4 drops 3 times a day X 1 month and then report SOS

Dr.Farokh Master describes Aurum Muriaticum Natronatum as the combination of the intrinsic factors of Aurum Metallicum and Natrum Muriaticum. The main theme of Aurum revolves around:  “I have to fulfill all my responsibilities, duties and ambition to feel absolved of my loss. Hence throughout my life, I work under severe pressure.”  The Natrum core is being vulnerable, reserved, closed, likes to be alone, sensitive, hurt easily and responsible.

George Vithoulkas describes the Aur Mur Nat personality as sensitive, refined and  subject to many fears. There is especially an inner fear that something bad will happen at any moment, giving them the feeling that they are fragile and need protection. They look helpless, go into a panic state. They do not express openness, and are rather timid and reserved and closed on first contact.  The mental state is of anxiety, anxiety about the future. If they are hurt, they are inclined to go into depression.

All symptoms are worse by REST.

Conclusion:

As quoted by Hippocrates “Natural forces within us are the true healers of the disease.”  This is just the principle that the science of homoeopathy follows. The medicines merely act as a stimulant to activate the vital force. The complete totality of symptoms of the individual state of each particular patient is used to cure the disease. In this case of Herpes Simplex viral disease, it was essential to understand the underlying anxiety disorder in the patient, which was eventually the trigger factor of the condition. Just treating the symptoms as done by repeated doses of antiviral drugs does not help to improve the condition. It is also important to guide the patient through dietary supplements and also focus on a healthy mind state, which eventually will lead to a more holistic healing of the body.