The following case illustrates three progressively deeper levels of simillimum, and the increased effect of each subsequent level. Identifying the striving for an absolute is what led to a deeper level of experience and a more effective simillimum. The final remedy would not have been found by the Sensation Method as it is not in any of the usual plant sensation families.
The following case was written by the student intern homeopath who took the case in the supervised MICH Intern Clinic. Attending intern observers and the student intern homeopath enter into dialogue. An experienced supervisor is present, but only intervenes when the process leaves the framework of dialogue, to guide the students back into the process.
The dialogue focuses on the deepest essence of the patient, and dialogue continues until there is group consensus that this essence has been reached. It is then that the materia medica is read thoroughly to determine what is the best similimum via the symptomology. Repertorization is used as it was designed: as a memory tickler for the homeopath, to provide hints for possibilities of remedies, and direction for materia medica research.
Christiane Magee (MICH clinic student intern)
1st Session: Jan 2015
51-yr-old male, small, short, but wiry, french speaking (case was taken in French). Presenting with symptoms of Trigeminal Neuralgia (5 years) and a medical diagnosis of Multiple Sclerosis (2 years). Could not sit for the case taking. Extremely fidgety and restless: got up from his chair after a few minutes and raced around the room incessantly. Exclaimed how much pain he felt, and how unbearable it was.
patient’s chief complaint, etiology, symptoms, history
- Constant since 2010 after a difficult wisdom tooth extraction. Five years of intense, constant, sharp, darting, burning pains in his jaw and up the left side of his head.
- Diagnosis since 2012. Family has history of MS, Epilepsy and Fibromyalgia (mother, brother, sisters). Difficulty walking, muscle spasms and shaking. Shooting pains moving around to different parts of body (patient would refer to them as “thunderstorms”). Pains originating from a “point” in his thorax. Loss of control of left side of his body. Legs blocked, jammed, feeling of amputation. Legs “jumping” at night – “shake like bacon” (vibrating). Worse during weather changes to damp, cold.
- At birth, was born a “blue baby” and required a blood transfusion.
- At 3 yrs old set his pyjamas on fire so he would be sent to the hospital so he could stay beside his brother (who was already in the hospital). After being admitted, he would walk around the hospital naked to shock and make the nurses laugh.
- Adolescence/early adult – history of excessive drug and alcohol use, criminal behaviour.
- Runny nose (clear coryza) and cough at waking in the AM.
- Symptoms come and go in a cyclical fashion, 2-3 weeks at a time.
- Inflammation (legs, ankles).
- Copious amount of saliva, tendency to drool.
- “Point prick” sensations – in thorax and jaw.
- “Thunderstorm” sensations throughout body – anticipates meteorological thunderstorms ½ to 1 full day before actual storm (his symptoms get worse in anticipation).
- Cannot wear socks.
- Tendency to clench jaw.
- Rheumatism, arthritic pains in joints.
- Pains make him vibrate, shake inside and out.
Apis 200k and 10mk, Aethusa 200k, Phytolacca 200k and 10mk
In this case, we see that each remedy was a good similimum at the time and aided in the healing process. What we saw was that as the patient was taken more deeply into his process with each remedy and case taking, the themes would be expanded upon and the picture would become more filled out. Each similimum was instrumental in the progression of the case, and as the case expanded, we could see each similimum’s place in the case.
After each case taking session, the first thing that the group does is to act out the dynamic of the patient. To try to feel what it is like to be living in his shoes, and to be seeing the world through his unique point of view.
first case taking & prescription
Prescription: Apis 200K followed by 10MK
The homeopathic team observes that the patient is unable to sit still. He could not sit for the case taking. He was extremely fidgety and restless and got up from his chair after a few minutes and raced around the room incessantly. Exclaimed how much pain he felt, how unbearable it was.
The patient put a lot of emphasis on his independence, and not wanting his work to be serious. He often played the clown at work. Thought that life should be centered around having fun, and felt confined by society, work and having to conform to society’s rules. He talked about people being “drones” within a structure, an order, and a hierarchy cohesion in society. Didn’t want to be a number. Loved nature because animals are free to be themselves as individuals.
The symptomatology, rubrics from repertorization, and the Sensation Method expressions seemed to point to the animal kingdom, to insects, and to Apis in particular.
Patient’s mind symptoms:
- Showing off
- Proudest of finding a “mate” for his widowed mother
- Silliness, silly laughing, making practical jokes at work
- Childish behavior
- Jokes, even when in great pain
- Not afraid of dying (repeated numerous times)
- Difficult to live with others, in the city, or in community; prefers living alone in nature
- Loves nature
- Relies more on instinct than the rational mind
Patient’s physical sensations:
- Vibrating inside, full of energy
- Pains like electric shock
Patient’s attributes which indicated the Animal Kingdom, and Insecta in particular:
- Violent reactions to threats to his territory, respect etc.
- Focus on “mating” and sexuality, food (bakes, cooks)
- Extreme restlessness
- Constant need for change
- Intense pace and speed
- Shamelessness (feces incident)
- Focus on death, being killed. Although insect remedy provings usually show a fear of death, Apis does not fear death. The patient also says he has no fear of death (or at least is extremely compensated around that issue).
- Sex, drugs, rock and roll
The Apis symptom picture of burning, stinging, smarting, prickling, lancinating pain, with excessive swelling, symptoms developing rapidly, sudden pains that extort cries, great restlessness and fidgeting, trembling, jerking and twitching seemed to be a good similimum for the presenting symptoms of the patient. Apis also addresses his tendency to joke during intense pain: “mirth, simulating hilarity when feeling wretched”. (Vermeulen Prisma rubrics)
The patient picture seemed to be covered by many of the predominant Apis themes of work, keeping busy, not finding one’s place in society, issues (one way or the other) with structure, order, hierarchy cohesion, organization, society, family and all the social constraints and the wish that his role was not a serious one. Symptom picture of burning, stinging, smarting, prickling, lancinating pain, with excessive swelling, symptoms developing rapidly, sudden pains that extort cries, great restlessness and fidgetiness, trembling, jerking and twitching further confirmed the similimum choice.
first remedy prescribed early february, 2015
- Rx – Apis 200K
Materia Medica for Apis
Highlights from Repertoire de thèmes et de matière médicale dynamique by Guy Loutan (translated by MICH)
Doubts that he can find his place in life – a place that is agreeable, interesting and fun. He wishes his role was not such a serious one, would like to play the clown. Why is the road of life so long, dirty and not fun? Has issues (one way or the other) with structure, order, hierarchy cohesion, organization, society, family and all the social constraints.
Wants the community to accept his originality, without holding it against him. The individual is more important than the collectivity. Refuses the idea of have to be dependent on a social organization.
The image is one of being vibrating inside, full of energy that must be expressed. Fidgety. Like the bee who attacks with a blind passion both the nectar and the intruder who tries to approach or touch it. They prefer to contain their emotions, and if they do express them, they do so “jerkily”.
Highlights from Prisma: The Arcana of Materia Medica Illuminated by Frans Vermeulen
“The Apis child is always restless, always wants to keep himself busy. These children have a kind of fickle inconsistency and slow march of ideas. Remember Apis when this kind of dullness is present along with restlessness and [busy] activity – the child constantly changes his occupation.”
Dr. Didier Grandgeorge:
“They [Apis] are individualists, and find it difficult to integrate into community life.”
1st followup & 2nd prescription
early march 2015
Trigeminal Neuralgia symptoms disappeared, MS symptoms ameliorated slightly. Symptoms for both conditions came back before 2nd session. Same themes presented during 2nd session. After a prescription of Apis, the theme of “instinct” became even more predominant during client sessions.
The patient said how if society followed their instincts and not rules, then the world would be a better place. The patient, in following his own very base, animalistic instincts, would create problems with those around him (society) and recognized that his instincts were not always the best to act on right away.
Themes of the case were still covered well by Apis and it was prescribed again and at a higher potency.
- Apis 10mk
2nd followup & prescription
The symptoms of the Trigeminal Neuralgia have gone completely. There are still some symptoms of MS, but with some amelioration. Symptoms for both conditions started to come back just before the 3rd session.
During this 3rd session, themes and delusions become more clarified and the theme of instinct becomes more dominant. We explored a little further with the patient and while his susceptibility to (stressors) remained similar, his susceptibility (conditions of existence) became more filled out and expanded on as follows:
- Society, rules, breaking rules/pushing boundaries/rules, people together like robots, just being a number, not thinking for themselves – not doing their part
- Being pushed
- Sickness & invalidity – him being sick, family being sick
- Nature – can watch the birds and animals for hours
- Instincts – being able to follow them without consequence (patient observed that his instincts have been wrong)
- Being an individual with/without an assigned role
- “Double-crossers”, injustice, people not doing the work asked of them
- Movement – being/not being able to move
- Money, finances (lack of)
- Stimulants, drugs and alcohol which are all taken in excess
In this 3rdthird session of case taking, we confirmed the same global themes (themes found in all areas of the patient’s life) relating to what threatens or reinforces the definition of self, as we found in the 1st session. We came to realize however, that the susceptibility was now more filled out.
After a prescription of Apis, the theme of “instinct” became predominant during client sessions. The patient focused on how if society followed their instincts and not rules, then the world would be a better place. The patient, in following his own very base, animalistic instincts, would create problems with those around him (society) and recognized that his instincts were not always the best to act on right away.
The conditions that the patient sets for his or her existence, the pattern that creates a sense of “self” which includes the worldview, perceptions, interpretations, and self-definition. The change in susceptibility will be the basis of the evaluation of improvement (FORCES).
In this case, the patient expressed dismay that animals can act infallibly (in his opinion) through instinct, whereas he felt that human reasoning is fallible. He wanted to make all his decisions, and felt that decisions should be made instinctively, not rationally.
He talked about not having choice as a fate worst than death, yet did not seem to recognize that operating from instinct is not really having true choice. The rational level of consciousness is required for choosing to occur.
His idea of relationships are that they should be “uncomplicated” by society’s rules, and therefore loved nature, and animals.
- He cannot stand rules and a society that blindly follows these rules [condition of existence].
- He is he who needs to rebel against those rules, and through bending and challenging these rules, cheekily shows society that they are not that serious – life can be fun [self definition].
- Nature is pure and ideal – animals can live in harmony by following their own instincts, not imposed rules. Society is not like this. [worldview]
- Pushes his rebellions to the very limit, but will not go beyond the point of no return – he is very aware of the limit and what the repercussions of his actions will be (e.g. will speed, not too much to be dangerous, but enough to get caught by police. Sent feces to a supervisor in protest of a health insurance regulation, knowing that he could not be reprimanded because he was on permanent sick leave.). If he must live in this society, he will assume the place/role assigned to him and do his job, so long as he is allowed to do so in his way. [dynamic]
Remedy Prescribed April 11th 2015
- Aethusa 200k
Highlights from Repertoire de thèmes et de matière médicale dynamique by Guy Loutan (translated by MICH)
Aethusa – Revolts against the fact that animals receive from God a perfect knowledge without work, and not him. Human reasoning is fallible but being able to make choices gives us dignity which instinct does not permit. It allows him to go beyond the animal. He cannot communicate that which he has not received and man must acquire this with difficulty. Desires simple links, loves animals and children; they give him this instinctual wisdom, infallible and without words. Aethusa’s idea of perfection is to have both animal instinct and conscious human intellect.
Using the theme of “instinct” we compared Aethusa and Chocolate.
Drug differentiation with chocolate:
Chocolate – Abridged from Per Neesgaard’s The Man, the Miasm, and the Modality (in Radar): “The guiding motive of Chocolate is to be able to act instinctively and surely, to be able to penetrate and see through things. The consequence of this is an uncertainty in action, as if there were a gap between thought and action. Chocolate feels excluded from all things. The guiding motive may be summarised as the contrast between nature (=instinct) and culture (=conscious action). Firstly, he feels excluded, forsaken, isolated, and lonely in relation to everything and everyone. He stands outside everything and can neither adjust himself to nature nor among people. Secondly, he does not know what to do. He considers something, but is unable to translate it into action. The matter of course involved in translating thoughts and conceptions into action is destroyed, as if there were a gap in between. In the compensation for the loss, he wants to try to show that he is capable of spontaneous and intuitive action, and to do that which at the moment is necessary and right. The emphasis might lie on a simple and natural lifestyle, where only the most basic things are needed. Living in harmony with nature and the animals. Living independent of human conventions.”
The picture of Chocolate gives us a person who is more deliberate in choosing their next actions and trying to manage instinctual action vs. deliberate, conscious action – there is a sense of hesitancy and deliberation. This doesn’t fit with the patient’s picture of someone who just goes ahead and does what he wants to do. He shows no hesitation.
3rd followup & prescription
May 2015 (Follow-up of Aethusa)
The patient now claims a 50% improvement of physical symptoms. Patient has stopped taking prescription drugs.
Theme and delusions become further clarified around a striving for complete freedom from any limitations which he equates with his definition of respect.
New remedy prescribed
- Rx – Phytolacca 200K
CORE STRIVING: Complete Freedom
Striving: A concept of an absolute that the individual strives to attain, the motive; it forms the means and ends of the dynamic movement of the patient totality of symptoms.
It became clearer in this session that the patient’s striving was for complete freedom without any limitations, regardless of circumstances. He wanted to be respected, treated with “dignity” and respect. He felt himself to be unique and deserving of respect, unique and individual. He said that everyone should have this right of dignity, because each holds a different and unique place within the whole. Each has his or her place within the whole, yet each has a unique source of individuality.
As we see in all cases, the disease often expresses or represents the exact opposite of the striving, or would be the greatest impediment of achieving the striving. His disease would make him dependent, thus taking away the absolute independence he sought.
This patient desires complete freedom from any limits or limitation of any kind, be it in food or drink, in his desires, his drugs, stimulants, his relationships, his actions and activities. He defines this completeness of freedom as “respect”. But respect for him really means that no one imposes anything on him. It was questionable as to whether he truly respected others’ wishes. Perhaps with the condition that they did not in any way impede his own. He finds human community and society too restrictive, and is in admiration of the animal kingdom which he perceives as the complete freedom to be who you are, without any rules to encumber that freedom.
The remedy picture is further filled out with the sensations, delusions and reactions.
Sensation words associated with source which come from the patient’s experience within the core striving.
- Being blocked – “lack of respect blocks me”
- Pushed – “they push me when they don’t respect me, then I become like a bulldog”
- “As if I’m handcuffed / ball and chain”, “treated like a dog”
- “I find my little hole, my little place.” re: work
- “Like a marionette.”, “Like an amputee.”
- Feeling of “thunderstorms” internally – electrical shocks
- “The cold makes me lose my legs”
- Burning, knife jabbing
Images from the patient’s imagination, personal interpretation within areas of susceptibility.
- Life is a game – there should be pleasure in life.
- Breaking the rules.
- Being respected.
- Every time I do what I want to do, I pay for it.
- Can live through it, endure it.
- If I can’t move, I may as well be dead.
Relating to Sensation Level plant reactions, columns, survival mechanisms if applicable.
- Controlled recklessness to show the sky won’t fall.
- Compelled to be on the move all the time.
- I’d prefer to be killed than suffer my pains – I’m not afraid of death though.
- Pushes physical self the moment pains are gone – disconnect from body. Very hard on his own body – hurts himself often because not careful.
- Protect, defend like a fight – like a bulldog when not being respected.
- Acting like the clown/rebel.
Materia Medica of Phytolacca
Highlights from Repertoire de thèmes et de matière médicale dynamique by Guy Loutan (translated by MICH)
- Sensation of needles.
- Adjusting into a bigger whole. Having to adjust to bigger context.
- Creativity – Feels that he can’t be creative, or has failed at creativity.
- Lacking delicacy and civility. Refused to adapt to circumstances.
- Lacks reason and tact.
- In community – together – oneness – having each piece to play it’s role. Have its place in space, dimension or limits. Freedom of limit – refuses all circumstances that impose any kind of limitation on him.
- Individuality, identity, solitude. Be his own centre. Doesn’t want to have to go around anyone else.
- Does not want to have to dress or depend on his environment – theme of complete freedom without limitations.
- Freedom without limitations without any circumstance.
- Respect and dignity – respecting everyone’s ideas, everyone being part of the bigger whole. Wants to be respected as part of the whole, but he doesn’t want to respect the whole.
- As if he is unique in the human species, as if he is his own species – deserves special treatment.
- The pains from his state are so unbearable that he would like someone to strike him on the head to kill him.
- Lack of sensitivity, acts with immodesty, does not adapt to any circumstance. Indifference, does not take the other into account, as if the other does not exist. As if he is unique in the human species, he does not accept the human community.
- Ameliorated by stimulants. Rejects that which can touch him, does not want to dress nor depend on the environment, but to get on by himself. The desire to “transcend” all limitations.
- He fears not being able to sustain the effort. He feels his insides hollow. He is weak, yet forcibly undertakes work which is too much for him.
(From Homeopathic Clinical Repertory – Murphy)
MIND: Pain, unbearable (p. 1664)
MIND; Business, general; averse to (p.1529)
MIND; Shameless, behaviour (p. 1687)
MIND: Death, general; desires, death (p. 1551)
GENERALS; Pain; unbearable, pain (p. 952)
GENERALS; Pain, general (p. 946)
GENERALS; Electric, current, pain like (p. 922)
GENERAL; Storms, general; agg, during (p. 974)
GENERAL; Storms, general, approach of a storm, agg. (p. 974)
GENERALS; Weather, change of; agg (p. 989)
GENERALS; Pain, general; wet, weather agg. (p.952)
GENERALS; Pain; appear, suddenly, the pains (p. 947)
CHEST; Sharp pain; extending, to; back (p. 317)
CHEST; Pain, chest, sternum; coughing, when (p.311)
LEGS; Pain, legs; extending to downward (p. 1350)
TEETH; Stiffness, jaws, muscles of lower (p.2154)
TEETH; Clenched, teeth, together, constant inclination to (p. 2137)
TEETH; Pain, biting, teeth together, when; amel. (p. 2145)
Highlights from Prisma: The Arcana of Materia Medica Illuminated by Frans Vermeulen:
- Worse: Rising from bed,. Motion. Cold. Change of weather. Rainy weather.
- Better: Rest. Warmth. Dry weather.
- Indifferent & Shameless: “Great loss of personal delicacy; there appeared to be a total disregard of all surrounding objects, and no disposition to adjust their persons under any circumstances.” “Sense of entire indifference to life, and disgust for the business of the day, on waking, early in the morning.”
- Restlessness with desire for motion, but motion aggravates
- Soreness all over
- Wandering pains – shooting, lancinating, flying like electric shocks
- Stitching pains upward and downward
- Pains appear and disappear suddenly
Highlights from Pocket Manual of Homeopathic Materia Medica and Repertory by William Boericke:
- —Loss of personal delicacy, disregard of surrounding objects. Indifferent to life.
- —Coryza; flow of mucus from one nostril and from posterior nares.
- — Irresistible desire to bite the teeth together. Teeth clenched. Much stringy saliva.
- —Feeling as if heart leaped into throat (Pod). Shock of pain in cardiac region alternating with pain in right arm.
- —Aphonia. Difficult breathing; dry hacking, tickling cough; worse at night (Mentha; Bellad). Aching pains in chest, through mid-sternum; with cough. Rheumatism of lower intercostals.
- —Aching pains in lumbar region; pains streaking up and down spine into sacrum. Weakness and dull pain in region of kidneys. Back stiff, especially in morning on rising and during damp weather.
- —Shooting pain in right shoulder, with stiffness. Rheumatism pains; worse in morning. Pains fly like electric shocks, shooting, lancinating, shifting rapidly. Pains like shocks. Pain in legs, patient dreads to get up. Feet puffed; pain in ankles and feet.
- —Worse, sensitive to electric changes. Effects of a wetting, when it rains, exposure to damp, cold weather, night exposure, motion, right side. Better, warmth, dry weather, rest.
Follow Up – Late June 2015
Post-dose, patient experienced 1 day of aggravation and then all symptoms disappeared. Symptoms returned after 5 weeks. Same themes presented in session, so redosed remedy in higher potency 10MK.
Higher Potency Prescribed
- Rx – Phytolacca 10MK
- Early Aug. redose – All symptoms gone after 1 day aggravation. Came back after 5 weeks.
- Early Sept. redose – All symptoms gone after 1 day aggravation. Came back after 4 weeks.
- Late Sept. redose – All symptoms gone after 1 day aggravation. Came back after 2.5 weeks.
Follow Up – Early Oct 2015
Higher potency prescribed
- Rx – Phytolacca 50MK
- (late Oct.) redose – All symptoms gone after aggravation, then came back after 3-4 weeks.
- (mid Nov.) redose – All symptoms improved after aggravation, but not as much as after previous doses.
Follow Up – Nov 26th, 2015
Phytolacca remedy action, when working, completely covers all aspects of the case. Main themes still present when client case taken again. Symptoms come back consistently in the same way as they did previously (cycle starts with little “pinpoint” sensation in thorax and jaw, and pains increase and extend into the “thunderstorm” pains throughout the body). After taking K potencies, the patient would habitually have an aggravation that would last 1 to 2 days. After the aggravation, all symptoms would disappear and patient energy levels would increase. Because of this cycle of remedy dose / aggravation / complete amelioration / return back to symptoms and condition, it is felt that Phytolacca remains the similimum of choice since the first given in May 2015. That said, the aggravations need to be managed through a change of potency.
● Rx – Phytolacca LM2, 2x/week
Follow Up – Late December 2015
End of Dec 2015 – Patient and Homeopath in communication via text message. Patient doing very well on the LM2 potency. Patient currently taking 1 dose, 2x/week. Aggravations post-dose last 30 minutes.
Christiane Magee, MICH Intern
Christiane is a MICH Intern and will be starting her 2nd career as a Homeopath when she graduates in mid-2016. Working previously in the corporate world of digital media, she discovered homeopathy in 2012 after attending a MICH open house and never looked back. She is excited to have found and to be finally starting a career in the transformative and holistic practice of homeopathy. To learn more about Christiane, read her profile in our student intern directory.
Kate Hudson – BA, E-Ryt, DHom, MICH Clinical Supervisor
Kate is a MICH Homeopath, and experienced workshop facilitator. She believes that the therapeutic process of inquiry is an important step in both the client’s return to health and in the path to selecting an appropriate homeopathic remedy to facilitate that. She works with clients from all walks of life, and has had particular success with those who suffer from anxiety and depression, or other mental emotional challenges.
The Montreal Institute of Classical Homeopathy offers a full four year program clinical supervision, accredited training in the homeopathic clinic in Honduras and advanced continuing education for Homeopaths.
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