Cyclic vomiting syndrome (CVS), first described in children by Samuel Gee in 1882, is a chronic functional disorder of unknown etiology that is characterized by paroxysmal, recurrent episodes of vomiting.
A boy aged 12 years was presented on 15-03-2016 with alleged history of frequent projectile vomiting and constant twitching of right cheek for the past 2 years. Investigations such as C.T brain, USG abdomen, endoscopy, etc., were taken by them previously which didn’t reveal any related findings.
CASE WITNESSING PROCESS (CWP)
“The way to experience the experience”
PASSIVE CWP (Exact observation)
Dr : Tell me about yourself. (on observation – he seems to be very weak and lean)
Pt : (Remains silent – on observation – he just looks at me without saying anything)
Dr : Tell me about you.
Pt : (Still silent) (He remains the same as if he didn’t hear anything. His father insisted he reply by sitting next to him, but he was still silent)
Dr : Please tell me, how are you ? ( He remains silent, then his father started narrating about his son’s issues……)
(Area: Physical Complaints)
His father: Sir he will be like this only, doesn’t talk much. Actually, he is suffering from nausea and vomiting continuously. It is projectile in nature. He will vomit around 10 -15 times /day. He will vomit immediately after food intake
(Patient slowly started to respond by his facial expression to me, so I started asking him again)
Dr : Did you have vomiting ?
Pt : Yes ! I have severe vomiting. I can’t eat anything, because if I eat something it will come out immediately. I can drink only small amount of water, but that too ends in vomiting sometimes. (on observation – his right cheek is twitching continuously every 3 seconds, when I noticed his cheek, he stopped talking )
Dr : Continue……
Pt : I had terrible headache also. It is more on this area (shows the frontal) and it will get reduced by pressure. I can’t talk. I feel very tired, fatigue and weak every time after vomiting. I feel the same and I feel thirsty for more water.
(His talk was in the natural flow, so I started to ask about the other areas.)
Dr : Tell me more about you in general. Likes and dislikes.
Pt : I like to play with friends
I want to talk to everyone.
I like children.
I like train travel.
I like friends gathering together.
I like more people
I like festivals.
I don’t like if my mother scolds me.
Dr : Little bit more about you…? Hobbies?
Pt : I like drawing.
I like to play together with friends.
I like to watch cinema in theatre with more people.
I like to collect coins.
I like to play Candy Crush; it is my favourite game and I will collect more
(He feels so tired and twitching of cheek muscles seems faster than before.
Again, he becomes silent)
Dr : Yes… .Continue…Tell me more. e doesn’t reply…Again kept silent for 5 more minutes……)
Pt : I don’t like to wake up early in morning. When, am playing together with my friends, I don’t like my mother calling me. (FOCUS: Correct interpretation)
(In passive CWP, in a state of Exact observation, together, collect, gathering coming again and again.)
ACTIVE CWP (Rational explanation)
(confirming the focus in the subconscious area)
Dr : Tell me about your Dreams one by one.
Pt : Dream 1 – More people are travelling in a train to our native place to gather together for festival.
Dream 2 – I was playing together with my friends, suddenly a ghost came and all my friends ran away to their home and I was left alone. I was afraid and doesn’t know what to do when left alone, then I suddenly woken up from my sleep.
(In subconscious area also the focus is together, so the focus is confirmed)
Dr : Tell me about togetherness in general…?
Pt : I like more people. I want everyone to be together. I like to play together with my friends and gathering with them for parties and festivals.
(Seems to be little active while talking)
Dr : Little bit more about togetherness…?
Pt : I feel together when collecting more coins.
I feel together when joining candies in candy crush game.
I like cinema theatre because more people will join together to enjoy the same show, but I will become very sad at the end of the show…because everyone will split from that place after the show.
(The remaining area in passive starts getting connected with the focus like, playing, festivals, collecting coins, candy crush games and cinema. So, I started exploring further.)
ACTIVE ACTIVE CWP (Scientific construction)
Dr : Tell me how do you feel when talking about together…joining…collecting…?
Pt : I feel good.
We are safe.
We are together.
We are collective.
Dr : Describe the experience of being collective.
Pt : It is like united. It is like connected, as if hold together.
(Suddenly his eyes looked down. He looked at his hands and does something…I was excited to see it and I was surprised that his hands were held together…His hands also speak the same…)
Dr : Just express the experience as it is right now within you.
(He is still looking at his hands intensely)
Pt : It is united. It is together. It is connected. It is held.
It should not get separate. It should not get split. It should not break.
(Tears from his eyes…Don’t know why…and now his eyes were almost closed…)
It should not break. It feels uncomfortable and I can’t be left alone.
Everyone of us were scattered. (His cries break his voice….)
It should not get separate. It should be together. I wanted to gather everything.
(Still his tearful eyes are watching his folded hands)
It should be collective. I can’t tolerate this splitting.
(now every pieces of the pattern united to the centre of the patient)
CENTRE OF THE PATIENT
together, collective, gather, hold, connected, united.
separate, split, scattered, alone, break.
Wants to be with more people, friends, relatives, cinema, festival and can’t be alone – not talking/not answering /aversion to conversation/introverted
Vomiting – projectile, frequently, 10 to 15 times /day, Agg-food
Thirst increased – large quantity, esp. after vomiting
Weakness, tiredness, fatigue esp. after vomiting
Twitching of right cheek
Headache -frontal. Pressure
Integrative holistic multidimensional approach
Sensation + Theme + PQRS at mental general + PQRS at physical general + PQRS at physical particular + Diagnosis = Similimum
|Sensation||Together, collective, gather, hold, connected, united / Separate, split, scattered, alone, break.|
|Theme||Want to be with more people, friends, relative, cinema, festival and can’t be alone|
|Mental general||Not talking/not answering /aversion to conversation/introverted|
|Physical general||Thirst increased – large quantity, Weakness, tiredness, fatigue esp. after vomiting|
|Physical particular||Twitching of right cheek, Headache -frontal. Pressure|
|Diagnosis||CVS – Cyclic Vomiting Syndrome|
Sensation approach: kingdom, subkingdom, sources
Plant kingdom – sensitivity & reactivity
Family : Fabaceae / Legume Family – scattered, split, fragmented / united, connected, together)
Thematic approach: Together /Alone /Connected/Unconnected/ Attached/Detached
Rubrics: PQRS at physical general, physical particular and mental general
Remedy: CYTISUS LABURNUM – Potency: 200 (Emotional Level of experience)
Holistic Understanding of Materia medica:
1.Botanical understanding of CYTISUS LABURNUM
Plantae; Spermatophyta, Angiospermae – Flowering Plants; Dicotyledonae; Rosiflorae / Rosidae; Fabales; Leguminosae / Fabaceae / Papilionaceae – Legume Family / Pea Family ; Cytisus Laburnum
2. SENSATION understanding in Sankaran’s plants
3.Mental general in Clarke dictionary
4.Physical general in Clarke dictionary
5. Physical general in Boericke’s Materia medica
6. Physical particular in Clarke dictionary
7. Physical particular in Boericke’s Materia medica
8. ALKALOID understanding in Vermeulen synoptic
9.Pictorial understanding by Sandra petri
10. Mythological understanding in book – “Trees: Their Natural history” by Peter Thomas
(In mythology also laburnum has a theme of union, together of different plants and divided or split theme. It is a graft-hybrid by different plants, wants to be together and it can’t be separate or exist as a single entity)
Follow up: (1st prescription: Cytisus Laburnum 200 one dose on 15-3-2016)
|31-03-2016||His twitching in the right cheeks stopped within 15 days of the first dose. Vomiting, headache, tiredness, attitude everything remains same.||Cytisus laburnum 200 one dose|
|29-04-2016||Frequency of vomiting reduced about 2 to 3 times/day only after food. No twitching but headache and tiredness remains same||Cytisus laburnum 200 once in 7 days for 28days|
|27-05-2016||Tiredness reduced, no headache, no weakness, vomiting reduced a lot, had only 2 times in that month.||Placebo|
|25-08-2016||No vomiting, no headache, no tiredness, no twitching
His weight increased around 2.5 kg in 2 months.
|19-10-2016||He was recovered completely, not feeling alone, not bothering inappropriately about together/separate.||placebo|