Name: Ms. B P Age/Sex– 4/F
Chief Compliant: Vitiligo for the last 6 months
History of Present Illness: It started 6 months back and was first noticed on the nape of the neck in the centre, followed by its spread on the face on the upper eyelid of the left eye. It gradually increased in size; on eyelid it was oval in shape and on the neck it was scattered.
On Examination: There is no numbness or pain or any other sensation or discharge.
Past Medical History: Nothing significant
Obstetrics History: This child was born by a C-section because there was no labour pain for the mother even after crossing the expected date of delivery.
Menstrual History: NA
Pregnancy History: As described by the child’s mother: Nothing significant was found except that her husband is a bit rude and abrupt in his behavior with her in routine.
Family History: Hypertension, Asthma
Thermals- Hot ++
Food and Drinks:
Desire: Sweets ++
Aversions: Nothing Particular
Perspiration: Profuse +, More on Scalp
Speed: Slow physically but mentally sharp. (Described Later)
Side Affection: Left (Direction of the spread of Vitiligo from site of origin)
Senses: Hearing: N
Sleep: N, sideways
On questioning about her disposition and interests what I got from her parents was that she is a sensitive child altogether. On further probing they told me much about her habits, that she has interests in drawing and coloring and they don’t need to push her to study or work, which she does by herself. She loves to hold the pen and try to scribble on her own. She is very much interested in getting a positive opinion for her work, like she says “I did everything well and I do good in my work and my teacher often appreciates me for my drawings”. I asked how does she react if you appreciate someone else in her presence, and they replied that she gets upset very easily. If we appreciate someone else, she will immediately go inside and get her workbooks and say “Look I got stars” and then demands appreciation.
She is a very good in her selection of clothes and accessories and dresses up very well and would always love to wear a matching ribbon to her clothes. She loves to do makeup and touch up to herself to the extent that she would never step outside if she was not properly dressed with matching accessories.
She is the only child and whenever any other cousin or child visits home and gets due attention it upsets her. She needs all the attention to herself only. She is very sensitive if someone talks to her in a rude manner or if she sees her parents fighting with each other and she starts crying. If her father points out anything to her especially in front any other child, then she gets offended and secludes herself until her father comes to her and apologizes. On asking further it became clear that it is not her father’s criticism, but that it is done in front of someone else which upsets her. “You can tell me if I am wrong but not in front of anyone”. What would they think of me?
Fears: Not much, except if someone shouts at her or when she has to go alone in the other room at night.
Observations: Oval shaped head with protruded forehead, average build, hair texture is soft; forehead is generally hairy with soft hairs and thick eyebrows. Not a very open child to strangers like me but responds well to any query and there was no hesitation after subsequent visits to get herself clicked for the records.
What we need to cure this patient is:
- Dominant miasm which is Syco Syphilitic. There is discoloration of the skin due to De pigmentation (Sycosis) due to death of the local pigment cells or due to autoimmunity at the level of thyroid or pituitary (Syphilis)
- The disposition of the patient along with the cause of the change in the homeostasis.
Rubrics which I got to select from:
Miasmatically this disease has manifested and as of now there’s no use of cause. As Master Hahnemann in his Organon has said, if a miasm has bloomed physically then there is no use considering what has caused it, but rather take care about its progression and further development. And as mentioned in Aphorism 81, the two miasms Sycosis and Syphilis are nothing but developed Psora and hence we need to take care of psora most importantly, i.e basic disposition and sensitivities to affect a cure.
Here the disposition and sensitivities of the child are that she is an Egoistical child (if her father points out anything to her especially in front any other child then she gets offended and secludes herself until her father comes to her and apologizes). Overall Sensitive child particularly to criticism and reprimands (if someone talks to her in a rude manner, “You can tell me if I am wrong but not in front of anyone”. What would they think of me?). Desires Appreciation for herself (if you appreciate someone else in her presence she gets upset. “If we appreciate someone else than her she will immediately go inside and get her workbooks and …demand appreciation). Creative (she has interests in drawing and coloring). Diligent Child (they don’t need to push her to study or work, she does it by herself). Coquettish (She is very good in her selection of clothes and accessories and dresses up very well, she would never step outside if she is not properly dressed with matching accessories). Jealousy (whenever any other cousin or child visits and gets due attention it upsets her. She needs all the attention to herself).
Chief complaint Vitiligo- SycoSyphilitic
From the above case taking and analysis we conclude that we need a medicine which should be hot, left sided, reserved, egoistic, sensitive, jealous and whose need is appreciation. The miasmatic dominance of the medicine should be Syco-syphilitic.
Here we are to consider the complete disposition and sensitivity of the patient to cure her Vitiligo, as it is a systemic disease (autoimmune). We shall see cure according to Hering’s law of cure in reverse order of appearance of the spots and spots should recolor from margins to inside, not like spot appearing in the middle of the scar; that would be the wrong direction. Vitiligo should always go in the reverse order of its appearance and by closing in from margins.
Rubrics considered for repertorisation:
We need confirmed rubrics which should cover the genetic disposition of the patient to cure her completely
Remedy Given is Calcarea Sulph 200 only one dose and Placebo for 15 days on 28/05/12
And analysis after adding other rubrics to confirm the remedy selection
Why Calcarea Sulph was selected?
We came up with the following medicines after repertorisation:
Nux vom: Nux vomica is surely a diligent remedy which this child is but firstly she is hot, and Nux is chilly. Secondly, Nux is a very introvert and an angry remedy. Nux will try to accomplish something whatever way is possible, so there is no sensitivity. Moreover, there is no creativity in Nux Vomica, hence not simillimum.
Sulph: Sulph is an easy going extrovert constitution with filthy appearance which contradicts with this child, though it is very close due to its creativity and sensitivity but Sulph is a non-diligent constitution and the hair of Sulphurs tends to be more messy and rough than smooth. Sulphur desn’t pay much attention to his appearance but only becomes fastidious in sycosis, and that too in a more critical manner, thinking big of himself. He might dress well but we’ll able to see mismatching in his clothing and his clothes are dirty, but he himself can’t see this.
Calc Flour– Again calc flour is a more business minded medicine with a sharp mind but lacks creativity and is emotionality different because of the flouricum component in it.
Calc Sulph: Is selected as calcareas are the most sensitive group in material medica. Here we see a combination of sensitivity and egotism at the same time along with creativity. So Calc sulph appears to be the best match for the case, carrying the sensitivity of Calcarea with ego and creativity of Sulphur. Moreover, she has a bony head with introvertedness and we all know how there is a need of appreciation in Calc Sulph.
Next step is follow up:
And follow up according to Hering’s law should be in the following manner:
- Reverse order of appearing of De-pigmented spots
- Spots should heal to normal from margins to inside.
- Sensitivities and Jealousy should normalize.
First Follow up:
No Change in spots
There was a sore throat with a low grade fever for 2 days which subsided by itself.
Placebo prescribed (Appearance of Psoric disease: good sign)
Second Follow up:
Better in general with improved appetite and there is appearance of pinkish hue in the white area of the spots which indicated improved blood circulation so, placebo prescribed for 1 Month.
Third Follow up:
On 25/7/12 – Size of the scattered patch on the neck started to shrink.
Medicine Given: Placebo
After 2 months:
Normal skin color coming up at the neck area
Medicine Given: Placebo
Fifth Follow up:
On 3/12/12 – Neck Better. She has again fallen ill, this time with cough and cold due to exposure to cold. No medicine was given
Medicine Given: Placebo
On 30/1/13 – The neck is healed up completely with reduction in size of the lid scar. Check Picture 2 & 3 – Medicine Given: Placebo
On 4/3/12 – There is healing of the spot which can be seen in Picture 4 as per Hering’s law of cure. Medicine Prescribed: Placebo
In final follow up on 29/5/13 we can see the spots completely healed up normal in Picture 5 & 6 all with a single medicine. Single dose of Calcarea Sulph 200, and here we can see the matching ribbon also.