A 35-year-old, male, properly dressed with hurried speech, presented on 12th of March, 2021 for the first time. By profession he is a mechanical engineer with a stressful job in a good firm. At this stage, he was suffering from chronic night and early morning coughing spells since 1.5-2 years. Dry+3 < anger+2, talking+3, with constant hawking+3.
He is extremely chilly+3 with zealous temperament and is a very adventure loving person. Thus, he was prescribed Nux Vomica 200 C and it took away his coughing spells totally.
On 28th April, 2022, he came back with his lab-reports of thyroid profile which suggested hyperthyroidism (TSH – 0.0083 uIu/Ml ). [ Fig. 3.1 ] The reports were double checked at one month intervals from different laboratories with similar findings. Hyperthyroidism was thus confirmed. The question was about the sudden appearance of this kind of condition in a very healthy person.
His current complaints are,
Pain +2 in joints of toes and fingers since 1 month. Pain in cervical region+1. He is unable to do heavy work with his hands and he can-not have a firm grip. Some weakness felt in upper-jaw. Numbness and tingling of limbs +1. After waking up in morning and putting legs on the ground he feels some kind of uneasiness in soles, as if multiples pin were pricking into his soles +2.
Obstruction and dryness of nose +2. (also mentioned at first meeting) He has to breathe from his mouth. No fixed modalities observed by the patient. Nose gets obstructed at any-time and anywhere.
Recurrent aphthae +2. ( Previously mentioned complain ) heaviness of tongue from this condition and difficulty in speech from the same. (mapped tongue on examination ) [ Fig. 3.6 ]
Warts in both axillae & face +1.
No coughing spells since last medicine.
Past H/o :
Dengue ( October, 2021 ) – Rx Allopathic medicines & platelet transfusion
Jaundice ( viral hepatitis ? ) – during childhood – Rx Allopathic medicines
Family H/o :
Father – Diabetes Mellitus, IHD – alive / 63 years
Mother – Diabetes Mellitus – alive / 61 years
Physical Generals :
Thermal – Chilly +3. Wears woollen cap in all seasons at night during sleep. Air of AC and fan bothers him very much.
Desires – Meat +2, Fish +2, Spicy food +2
Aversion – Milk +3
Occasional smoking +1 and alcohol consumption +1.
Appetite – Easy satiety from little food +2.
Refreshed after short sleep +3. Sleep gets disturbed very easily from slightest noise +2. Sleeps mostly on left-side +1.
Mental Generals :
Pt. – I am a free-minded person. Easily mixes with others. I love to be in nature. I like to make new friends. Once I meet someone, I can easily make a bond with them. I am a fun-loving person. I like joking and mocking around.
Dr. – Are you irritable or get angry anytime?
Pt. – Yes, sometimes I get angry but not often. If someone abuses me then I get angry and I can hit the person in anger. Once in my childhood, one of the friends was abusing me and so I hit him with the bat.
Dr. – Are you very ambitious or competitive?
Pt. – Not competitive. But I made certain records at job. And I like to be first in my work. I have decided my future goals and achievements and I work hard for them. But I don’t put down others for my work.
Hobbies – I love biking and adventurous sports +3. I like to go at mountains and beaches. Me and my group do adventurous sports like sky-diving, biking to Ladakh, Jet-ski, etc… I have done almost all the adventurous sports. Sometimes, my friends get scared of the things but I volunteer myself to go first and try first many things. Last time we went on certain feet of height in one flying vehicle and came down in a spiral pattern in the same vehicle. It was very extra-ordinary experience. I love such risky work. I feel happy and kind of thrill from inside.
(Patient came near to my chair with mobile and started showing pictures of his adventurous activities. )
Pt. – Work is little bit stressful since last few months. We expanded in all India. So, now we take orders from all India and have to supply back, so yes, work is little bit more, but I like to be busy. I work now-a-days 8-10 hours a day, but, I don’t bring my work to my home. I am also thinking to do a side business along with my job so, I am planning for the same. I have lot of plans & thoughts while going to bed. As if mind were working continuously and may be that’s the reason of my very short sleep. But I get up fresh in morning. I never felt sleepy of lazy due to loss of sleep. In a month, I have sometimes 1-2 days during which I put everything aside. I put my work, mobile phone everything aside. I don’t like it and then slowly everything comes back on track.
( Patient is clearing his throat during whole interview +2.)
General Examination :
Weight – 73 k.g. ( previously it was 75-76 k.g. as per patient )
SpO2 – 99%
Pulses – 110 / min. ( tachycardia of Hyperthyroidism )
Totality of Symptoms & Repertorial Totality:
- Industrious +3
- Adventurous, Courageous +3
- Chilly +3
- Desires Meat +2, Fish +2, Spicy food +2
- Aversion to Milk +3
- Easy satiety from little food +2
- Short sleep +3
- Sleep gets disturbed very easily from slightest noises +2
- Sleeps mostly on left-side +1
- Pain in joints of toes and fingers +2
- As if multiples pins were pricking into soles in morning on first steps +2
- Obstruction and dryness of nose +2
- Hemp & Hawk while talking +1
- Recurrent aphthae +2
- Mapped tongue +1
- Warts in both axillae & face +1
- Hyperthyroidism +1
Analysis :
There are many remedies indicated here. If I look at repertorization result then Nux Vomica is again indicated which has helped him somewhat previously in 2021. Looking at his open, communicative personality with some physical generals one may think of Phosphorus. Natrum Carb. also chilly remedies. Natrum family has affinity for thyroid gland as well as pain in small joints; they have aversion for milk, also.
However, during case-taking process his adventurous personality was out-shining other aspects. By looking for such personalities I came up with two remedies Tuberculinum & Medorrhinum.
Medorrhinum is a sycotic remedy. If I compare the materia medica with this case, I find many symptoms either particulars or generals matching with remedial pathogenesis. The description given by Dr. Roger Morrison is as follows, [ 1 ]
We will almost never come to prescribe this remedy on the basis of repertorization. Therefore we must have a high index of suspicion when we take the case to find this remedy when it is indicated. Although many cases will not have any hint of the typical mental symptoms of Medorrhinum, it is often the personality of the patient which leads to the prescription of this remedy.
The Medorrhinum patient may look quite a lot like Nux Vomica – a workaholic type. The Medorrhinum patient can be described as an extremist. In his physical pathologies, in his mental state, in almost all aspects of his life the patient bounces between extremes: his grades are either “A’s” or “F’s”; his work is brilliant at one moment and then inept…
He is erratic and seems to have a compulsive need to experience more passion until he is driven to extremes of sexual conduct, drug or alcohol use, physical violence, etc… Excessively passionate people who are led to problems from strong needs for expression of the passion. Desire to experience everything. Loves the forbidden.
Prescription :
MEDORRHINUM 200 C – single dose, 4 pills to be dissolved in ¼ cup of water. S. L. – TDS
Follow Up : ( 23rd June, 2022 )
Weight – 76.05 k.g. (increased )
SpO2 – 98 %
Pulse – 90 / min. ( reduced )
TSH – 11.03 uIu/Ml [ Fig.3.2 ]
R.A. – 6 mg/dL
Better in energy. Backache in lumbar region < standing on right leg. Pain in joints of fingers & toes are same.
Reduced aphthae. Reduced pricking sensation of soles.
No change in warts.
(Here, improvement in weight and pulse are in favour of right direction to cure, but increased TSH is indicating the hypothyroidism. The questions arises, what happened to the patient? Is he now suffering with hypothyroidism? Should we think of another remedy? Was Medorrhinum the correct prescription?
Prof. Vithoulkas writes: , “ Medorrhinum is a remedy that goes to extremes in its pathology on all three levels. It seems incapable of maintaining a neutral, stable state. It is fitful, unstable, going from one extreme of pathology to the other ”. [ 2 ]
In this case, the TSH level also got a swing from one extreme ( hyperthyroidism) to another extreme ( hypothyroidism ). This result is suggesting that the action of the remedy is still at work and we must wait before hurriedly prescribing another remedy.
Prescription : Continue with S.L. – TDS
Follow Up: ( 2nd August, 2022 )
Weight – 76.65 kg.
SpO2 – 99%
Pulse – 90 / min
TSH ( 31st July, 2022 ) – 6.78 uIu/Ml [ Fig.3.3 ]
Very good energy. No backache. No pains of joints of fingers & toes. No pricking sensations in sole in the morning.
Aphthae reduced by 30-40%.
No change in warts.
Prescription : Continue with S.L. – TDS
Follow Up : ( 22nd September, 2022 )
Weight – 76.65 kg.
TSH – 3.5262 uIu/Ml [ Fig.3.4 ]
Prescription : Continue with S.L. – TDS
Follow Up : ( 18th January, 2023 )
Weight – 76.95 k.g.
TSH – 3.653 uIu/Ml [ Fig.3.5 ]
Prescription : Stopped all medicines altogether
Lessons from this case :
- It is not necessary that from the first few remedies of your repertorization, you will get your simillimum. Repertory is only a tool to ease your hectic search of Materia Medica. When the knowledge of repertories and materia medica go hand in hand, the successful miracles happens in homoeopathic practice.
- Sometimes, the medicine may work for weeks or months and this case is the proof of that. Be very cautious in changing prescriptions every week or every fifteen days. Allow time for the remedy’s action, especially when there is no immediate danger to health.
References:
- Morrison Roger – Desktop Guide : To Key-notes and Confirmatory Symptoms, ch. “Medorrhinum”
- Vithoulkas George – Essence of Materia Medica, 2nd edition, ch. “Medorrhinum”
