This is the case of a lady who came to me for treatment of chronic vertigo and headaches. Her first visit was at 10th of March 2015. She was a thin woman in her early forties, with yellow complexion and dark hair. Her manner of speaking was snappish and she was talking rapidly but she had mild tone to her voice. She was also impatient on her chair, sitting with her arms crossed before her chest. In the course of case-taking she briefly revealed a list of complaints which showed general miasmatic derangement of her nervous system. My first prescription proved to be close but it was not the simillimum. Her true chronic remedy became obvious to me a few months later, due to an acute condition.
She reported periods of dizziness, starting suddenly and increasing to violent vertigo. It was a congenital complaint, all women in her family had suffered from it. She started to feel it from time to time, after having her elder child born 13 years ago. The last two years it had increased to a severe intensity, causing her to stop functioning until the subsidence of paroxysms. She had tried allopathic treatment with temporary alleviation; she had also tried some pseudo-homeopathic therapy with combined preparations, again to no permanent avail.
“It starts out of nowhere, usually while I am stooping for something. I lose my balance, each stooping aggravates. Rising from stooping is awful. I must sit at the table and support my head with my two hands, and it feels as if everything is falling from above on my head. Lying makes it worse. I must take some combined homeopathic preparation from the pharmacy in order being able to fall asleep. On the next day I usually have a severe headache starting in the nape of my neck and embracing my occiput.”
“Other times the room turns over, all of the sudden. I feel as if I am riding on a merry-go-round and will fall sideways, on the right. I also try not to move my head and to stand with my body upright; I try to move the entire body but not my head, at any cost. I have the feeling as if there is a ball on top of my head, and if I bend the head to any side that ball would roll down to that side.”
“These attacks come periodically. I cannot say if they depend on something. They just happen suddenly.”
“Sometimes I wake up with a very strong headache in the morning. It happens periodically. The pain is at the back of my head, sometimes on one side; sometimes it is dull; and sometimes is lancinating, as if someone is driving in a nail with hammer. And often this pain is attending with nausea and vomiting, and sometimes with high blood pressure – 160/120. Sometimes it starts after my period but not each time.”
“I often feel heaviness in my head, which continues for days. Drinking coffee brings but little help.”
PALPITATION OF HEART & UNSTABLE BLOOD PRESSURE
“I have had slight arrhythmia periodically, since my school days in puberty. But last two years it starts suddenly, and very violently. My entire body is shaking, my heart beats so strong, it’s rumbling, as if it will jump out of my chest. I must lie down, this always helps. The palpitation continues after lying, and gradually stops. I then feel very weak. My mother and my husband say that my face becomes extremely pale while I’m just lying flat on my back; they even called an ambulance last time; but till it arrived all was passed and doctors found nothing.”
NERVOUS & EMOTIONAL EXCITABILITY
“I am very nervous, very impatient, and very emotional. I easily get impressed by trifles really, and make a mountain out of molehill. I cannot stand clamor; but at the same time I often shout for nothing, especially before my periods. I’m so worried about my obligations; about not being on time with my kids’ school; about my work. I’m anxious whether I could cope with so many obligations. I feel unable to adjust myself to the changes in my routine.”
“I feel anger in front of injustice but I never express it. I leave it unsaid and I feel apt to weeping. Often I just begin to weep while I sit and do nothing” – and at this point she started to cry and wipe her tears.
“I’m not very apt to clean and tidy up my house. I like being with people, part of big company, I like to go out and laugh.”
“It is very difficult when I have to make a choice or decision. I need support.”
BACK & EXTREMITIES
“I have exostosis on the thumb of my right hand, inner side, which gives me much pain from time to time, in periods. Sometimes it is movable: periodically it’s protruding and then again sinks. I noticed it about two years ago. The pain is sharp and I cannot work (she works on a computer). Pressure and external cold make the pain worse, external warmth alleviates it. I tried to bandage it, pain got worse.”
“My neck is numb, stiff. I feel it stiff there, in between, above the shoulder blades. When I lie down on my back it ameliorates.”
SUPPRESSION OF MYOMA
Her period had been extremely painful prior to her first pregnancy. Severe pain in the entire abdomen and sacral region leading to inability to stand or walk. After the labor all gone, menses regular and painless, pure blood without clots.
During her first pregnancy she was diagnosed with cervical ulcer and HPV negative cervical dysplasia of third degree (CIN III). After birth it decreased to CIN II, and few months later to CIN I. No interventions.
She reported heavy hemorrhage in 2013. In hospital they diagnosed her with myoma in the uterus. She had it surgically removed right away because she was frightened from the intensity of hemorrhage.
“One week before each period I become highly irritable. I shout at any occasion. My breasts are painful and enlarged, and also my abdomen is distended.”
On my question, had she noticed any leucorrhea, she answered: “I notice it all the time, for as long as I have periods. Menses stops, and in a few days leucorrhea starts, then again menses comes and so on. The leucorrhea is thin, watery, of transparent to white or light-yellow color. It becomes stronger before and after periods, and decreases a bit in the middle. Sometimes, just before blood starts to flow, a large quantity of mucus drops out.”
Here I also asked her about the color of her face. “It’s always been yellow” – she said.
She is very chilly with aversion to meat and fat, salt and sour foods. She hates swimming in the sea and generally aggravates at the seaside. She’s been prone to constipation all her life.
THE FIRST PRESCRIPTION & FOLLOW UP
It was apparent that I needed to find a remedy with deep miasmatic action on the nervous and female genital system. A few points made me dwell in reflection as to which miasm I had to direct my efforts first. The myoma, and later the exostosis, were signs of typical sycotic expansion. The cervical dysplasia showed danger of cancerous affections, indeed in latent form but perceivable. On the other hand, the general derangement of nervous system, which caused her inability to function properly at all levels, affecting CNS and causing general imbalance, affecting heart action and causing fluctuations in the blood pressure, together with the increased nervous and emotional irritability – all these made me see the underlying latent psora which started to manifest during her first pregnancy but became fully unfolded due to the suppression of the sycosis (see S. Hahnemann, ‘The Chronic Diseases’, Symptoms of Latent Psora).
Though it is true that miasmatic layers must be treated one after another starting from the most pronounced one, it is quite difficult to distinguish such fine characteristics in a patient, which leads us to the simillimum and at the same time has anti-miasmatic action. One may, of course, insist and ask the patient to share more details about his/her personality in an attempt to see the reasons underlying the manifesting symptoms and thus to arrive at the precise prescription. I however have discovered at my own account, that people tell only things they are ready to tell and if I insisted they would lead me in the wrong direction. Moreover, this particular lady was so nervous and disinclined to speak that I had to deal with what she had willingly shared to this point.
When I put her symptoms into my repertorization software, Sepia forced itself to my attention due to its close relation to patient’s morbid sensations and miasmatic layers. Indeed, her case looked pretty much a Sepia case; I had only one doubt: she had an aversion to sour food. Nevertheless I decided to prescribe Sepia because of its deep antipsoric action and its deep influence on the female organs, nerves and circulation. There was also one particular observation I had, which was also key feature of Sepia: her yellow face, together with her constant leucorrhea. In Complete Repertory there are seven remedies in that particular rubric:
Face; yellow; leucorrhea, in: caul caust chin ferr LYC NAT-M SEP.
Hering writes about Sepia in his “Guiding Symptoms”: “Hemicrania in hysterical women; pains stitching, pressing, tearing or twitching with passive congestion of head; in chronic cases where the nervous system has long been disordered; leucorrhoea between menses; sudor hystericus, peculiar sweet-smelling sweat, particularly in axillae and about soles of feet; face pale, dirty yellow, slender built.”
I will not go into details about my reflections about not choosing some of the other six remedies because none of them covered my understanding of the essence of my patient’s personality; though Natrum muriaticum and Lycopodium looked very closely similar to the case, both in the general and local symptoms. The same was valid for Pulsatilla (not present in this rubric) and Ferrum metallicum. Neither one of those remedies nor Sepia were the right choice. Sepia however helped the lady to manifest other important characteristics, which belonged to the chronic totality of symptoms. My point in this article is to show how the very similar remedy works to remove a layer in the patient’s diseased condition but has no power to bring deep cure. We shall see below how Sepia lead me to the true simillimum.
I also want to mark here that I took the rubric ‘Generalities; periodical’ in my first repertorial analysis. But I neither should have taken it nor to underline it. Indeed she often used this word ‘periodically’ while telling her symptoms; but actually in her case there was no real marked periodicity. I was unable to determine the periods of appearance of her symptoms. The latter appeared more chaotically than periodically.
There follows a snapshot of my first analysis chart as of March 2015 (analysis copied and patient’s personal data removed):
FOLLOW-UP FIRST PRESCRIPTION
Gradually, for three months after Sepia 200c the lady felt general amelioration. The remedy was given once on 10/03/2015 and repeated on 19/05/2015. Her paroxysms of vertigo steadily became less intense and less frequent (about 60 per cent amelioration). The exostosis on her hand stopped aching. The leucorrhea substantially lessened in quantity and duration but still appeared two weeks before her periods.
She reported less irritability and better management of her daily obligations and lack of anger attacks. No heart palpitation appeared during this period. However there remained the heaviness in her head and headache still appeared unexpectedly in the mornings, less intense but still disrupting her day. She made blood tests on my request and they showed that levels of hemoglobin were very close to the lower margin. Her face was still yellow, and her anxious expression – face and manner of speaking was not gone. Constipation was better but still present. The blood pressure was stable.
Summer passed without news from her and in the middle of October she called for appointment.
RELAPSE & NEW TAKING OF THE CASE
“I was doing well”, she said, “And then we went on vacation at the seaside. At first nothing in particular was happening but my head was gradually becoming heavier each day. Also my right ear gradually became stopped with some unclear irritation; not real pain but as if there was water inside, or I was feeling something like gnawing deep in the internal ear.”
“Then in the beginning of September we came home and in the next morning I woke up with terrible headache as before we started this treatment. I didn’t call you, just repeated the remedy you gave me because lots of time had passed and I decided it had stopped working. On the next day I felt okay and I was okay for two-three weeks, except for the heaviness in my head and the stoppage of the right ear which did not go away. And while I was thinking that I’m better, one evening, I think a week after I repeated the remedy, suddenly my arrhythmia came back. It was the most severe heart palpitation I’ve had for a long time. My entire body was shaking. It passed relatively quickly in about 15 minutes, after I lay down. Since that evening, I often feel as if palpitation would start again – during the day while I’m at work – but haven’t had such severe attack again.”
“Then I caught up some virus. It was fluent coryza at first, rivers of yellow discharge flowing at the back of my throat, which was hurting, and I had dry irritating cough. I had heaviness in my occiput and in my forehead, my nose was stopped. The headache came back with pulsating and feeling as if someone is driving in a nail with hammer. The coryza went away for a week but I cannot stop coughing, it’s been another week already. I feel pain under my diaphragm every time I cough, it is pain as from the cough itself, sore bruised sensation.”
H: What more can you tell me about the cough?
P: “Dry and irritating cough; I constantly feel irritation inside my larynx as from a feather. When I start to cough, it can’t be stopped. It comes in paroxysms and I’m coughing to suffocation. It’s not happening outside but only in closed premises – at work, at home, in the transport. This cough I have each time when I catch some flu, and it becomes almost constant for weeks after the acute have come to pass. It’s increasing in the evenings at home to an impossible degree, until I go to sleep. As my head touches the pillow, the cough stops and I sleep all night. But when I get up in the morning it starts all over again. I feel very tired from it.”
WHAT TO DO NOW?
I took the entire case again. After careful questioning she brought in only two further details to the above chronic picture; the rest were symptoms characterizing her acute condition as well as relapse of her chronic complaints.
The first symptom not mentioned during the first case taking was the stoppage of her right ear. “I’ve had forgotten about that ear. Periodically I was feeling it as if there was water inside and I hear as if from a distance. This stoppage was appearing from time to time with my vertigo attacks, or with the heaviness in the occiput.”
The second symptom was the cough. It became obvious that each time she had acutes, this dry suffocating cough appeared and would not go away for weeks after the acute. The most important modality about the cough was its disappearance from lying down in bed. And that lead me to her remedy, for it’s a key feature of the latter.
There was one other circumstance which also suggested to me the mineral kingdom remedies. That was her threatening anemia.
I made a new repertorial analysis adding the newly discovered chronic symptoms plus one symptom belonging to the acute condition; the latter I gave no weight, I just wanted it visible for comparison. Of course, Nat-m and Sepia were still heading the list of remedies. But now I was searching to see which remedy was embracing all peculiar characteristics of my patient’s disease, while having the following characteristics itself: action on the internal ear, action towards anemic conditions, action on the larynx and trachea. That remedy was Manganum aceticum, and it cured my lady patient completely.
Our Materia Medica is a bit confusing about manganese remedies Manganum metallicum, Manganum carbonicum and Manganum aceticum. We all know that Hahnemann’s proving was made by triturations of acetate and carbonate of manganese. The Complete Repertory contains many rubrics of Mang-acet but still the remedy doesn’t show itself without applying some filters to the analysis. I chose Manganum aceticum not only on the account of its close similarity with the key features of my patient’s disease; but also because it fit most to her weak anemic pre-disposition; I also considered its close relation to Aceticum acidum. My leading source of MM was Hahnemann’s MM Pura. I will only add two quotations here, one from J. H. Allen and one from R. Hughes:
Allen, J. H., The Chronic Miasms: “Indicated in waxy, chlorotic, pallid, sickly, tubercular women who have great anxiety and fear as if something were going to happen; sad, low-spirited, silent also. Leucorrhoea in chlorosis or pernicious anaemia (Ferrum, Ars.)”
- Hughes, A Manual of Pharmacodynamics: “Triturations, or in the case of the acetate aqueous solutions, are made for homoeopathic use. A pathogenesis of Manganese, obtained from the acetate, appears in the sixth volume of the Materia Medica Pura. It contains 89 symptoms from Hahnemann, and 242 from ten fellow-observers. A second pathogenesis was published in the second edition of the Chronic Diseases, adding to these the 124 symptoms recorded as obtained from the drug in Hartlaub and Trinks’ Arzneimittellehre. Hahnemann’s provings led him to think that Manganese would prove indispensable in some of the most troublesome chronic diseases, especially some insupportable pains in the periosteum and joints, some weaknesses of the senses and some affections of the larynx and trachea. The provings of the native black oxide and the chloride since instituted by Dr. Lembke, of Riga, on his own person-an account of which is given by Hempel and Allen-confirm the first and last of these actions, and show it to affect the head much like Ferrum. The hoarse cough it causes is characterised by being relieved on lying down.”
Manganum aceticum is not frequently used today, which is indisputably a mistake, for it has deep antopsoric action and stands very close to Ferrums, to Aceticum acidum, and – as my case shows – to great polychrests like Sepia, Natrium mur and Lycopodium. It proved to be efficacious even in acute conditions; which is not at all surprising if we turn to our old classical sources of Materia Medica more often – as we really should.
On October 15th 2015 I gave Mang-acet 200c in water solution to be taken several times for one day. The lady reported severe aggravation of the cough on the same evening and during the next day. Then gradually the cough disappeared. She called one more time on the phone and said that all is well, only her heart sometimes beats not rhythmically. I asked her to come for a follow-up about mid-November.
On that last follow-up she said that sometimes she feels as if palpitation would start while she’s at work. The stoppage of right ear had disappeared. No signs of vertigo, no heaviness or pain in the head. Constipation gone. Leucorrhea better on 80 per cent. She felt calmer, and, while she was speaking I suddenly noticed that her face had turned from a deep yellow color to a pinkish nuance. I asked her if she had noticed that, and she confirmed: “For the first time since – well, I don’t remember when, but yes, my face is not that yellow now.”
I prescribed Manganum aceticum in LM6 potency for three consecutive days, and told her that she can take the remedy again if some of her symptoms should return. She called me once more a few weeks later, to say that she feels very well – no arrhythmia, blood pressure normal. That was our last talk.
Thankyou for sharing this interesting case Tsevtana. The process is described clearly and is a great description of how an acute episode can lead to the chronic remedy.