Clinical Cases

A Dogged Case of Psoriatic Arthritis Hypertension and Ophthlamic Shingles

Last modified on May 18th, 2014

Homeopath and teacher Douglas Falkner solves a case of psoriatic arthritis using basic Hahnemannian principles including impartial case-observation.

I’m presenting a case of serious and diverse pathology which was cured by an unusual remedy.  I would also like to demonstrate how understanding basic Hahnemannian principles along with impartial case-observation, and facility with repertory and materia medica, are sufficient to solve almost any case.  A simple approach, emphasizing objective observation, not complex systems, can consistently lead to accurate prescribing and high rates of cure.

When I take a case, I interject myself as little as possible, allowing the patient to speak their truth fully and spontaneously without interruption. As part of the traditional doctor-patient relationship, one of our jobs is to deeply honor the healing process which begins in the consultation room.  With the proper intent, we can create a kind of sacred space for our patients in which they can express and reveal what is most important.

The following is a case of a burly man in his late 40’s. He has a marked ruddy complexion and a gentle way about himself.  He presents with the diagnoses of psoriasis, psoriatic arthritis, hypertension, and herpes zoster of the left eye.

The following narrative is what he shared with me, more or less verbatim.  My own statements or commentary, added for instructive purposes, have been incorporated into the narrative in parentheses.

Please tell me why you came and how I might be of assistance?

I came to see you because the spiritual component of homeopathy really intrigued me.  I spent twelve years in Catholic school, after all. But let me back up.

I am the oldest of three boys.  I was raised by a young and strict mom.  I was force-fed Catholicism at a young age.   In our house it was “don’t speak unless you are spoken to.”  I rarely got a choice about things.  Basically I lived in the shadows, afraid to express myself.  When I tried, it felt like I was never listened to.  I had this morose, sick feeling.  I just felt like shit!

(Already we get a strong impression of this patient.  Almost immediately there emerge images of emotional suppression, things imposed against the will.  He was “force-fed”, “rarely got a choice”, “lived in the shadows”, “afraid to express”, “never listened to”.  All these combined led to a “morose, sick feeling”, “I felt like shit”.

Over the years, in reviewing many cases where the first prescription produced what we homeopaths call miraculous cures, I have found that strong elements or pointers to the remedy quite often appear right at the beginning with the first words or non-verbal expressions of the patient, sometimes even before—such as in the waiting room, or when the patient calls to make the appointment.  It is as if the living organism, as a result of the existing vital disturbance, is always expressing what needs to be cured, if we are only willing to observe it.

In retrospect, I found in this case as well, the key components of the remedy were offered up right out of the gate.  We know his opening statements are important because they directly reflect how his individual disease state has been undermining his constitution: he has a “morose sick feeling, I felt like shit.”

Knowing that crucial information not infrequently arises in the very beginning, the challenge is to avoid seeking the remedy or thinking too much about possible remedy choices at this early juncture.  In my opinion, the student or beginning homeopath ought not think about remedies at all when engaged in the process of case-observation. Better to keep the mind fully attentive and present, open and clear, so that the complete pattern of the disease can emerge, untarnished by bias or prejudice. During case-observation, our immediate task is not to look for the remedy, but rather to strive for a complete understanding of the living human being we are engaged with.

The patient continues:

Catholic school was a living hell. I fought it how I could in little ways.

It was a constant battle I couldn’t express.  My inner rebellion was hard on my body as a kid.  I moved away from home right after high school.

(Again, the patient tells us that he couldn’t express, but he does have an “inner rebellion” that is “hard on his body”, thus his inner dynamic is contributing to his state of illness, not to health and wellbeing.)

My father was a staunch republican and businessman for a big oil company.  My “evil” mom kept a super-duper tight ship.  Once I moved out she was “whatever” about it.

In my teens, twenties and thirties, I was really hard on my body: worked hard, played hard, crashed hard.  I had four major knee surgeries and multiple broken bones.

My arthritis stuff started in my late 20’s.  I just forced my way through it.  A joint here or there exploding.  It overcomes me, takes me over.  The inflammation and burning pains are killer.  They come with more frequency in different spots.  I keep trying to peg the rhyme or reason for it.  Haven’t been able to knock down these constant bouts.

(At this point, we hear more about his life dynamic of being hard on his body—mentally, emotionally, and physically.  His strategy is to try to “knock down these constant bouts”, basically trying the same strategy that was enforced on him: self-suppression.)

My current marriage has never been happier.  I hold in a lot of anger, I am so riled by the world.  I take it all to heart, all what these politicians do.  I carry the world of events in my heart.  I’m so upset—I want it one way, the right way.  Like a lack of control about being able to help, help the down-trodden—the underdog.

Look at me barfing all this stuff out…

(I always keep a close eye on the choice of words people use.  When he describes the manner in which he expresses himself, he uses the word “barfing”—“look at me barfing all this stuff out.”  So for him, in order to speak about himself, to speak his truth, he has to “barf” it out.  It has to take a violent expulsion, rather than a simple, flowing, natural, personal expression.  To “barf” requires overcoming the suppressive force of the esophageal sphincter on the stomach contents, whose purpose is to hold its contents in.)

You see, I wasn’t allowed to express anger as a kid.  I hold it in, hold it in, then one little thing can set me off in a rage—though I am never violent.  It is a seething anger and frustration.  I didn’t fully know what I was feeling.  I was never allowed a choice, like I wasn’t valued.  My opinion, thoughts or wishes just didn’t matter.

(Even in rage he held himself back—“never violent”.  Thus more evidence of suppression.)

Why is masturbation a sin?  Why are women second class?  These values were crammed down my throat.   Catholic school was a living hell: the priests and nuns were violent, all the structure of uniforms and conformity.  It was all forced—I was never allowed a choice.  The cloak and dagger, fire and brimstone, and it was all false.

(“Crammed” and “forced”, all words reinforcing our observation of the many levels and facets of suppression operating in the case.  “Never allowed a choice.”  He reiterates these images from the beginning of the case, and they weave through to the end. We are thus much more secure in our understanding of the importance of the suppression in his pathology. It is becoming evident that we are moving in the right direction and the image of the disease is emerging nicely.)

There was this heavy set kid in class who was ballistically shy. He always got the ruler on the knuckles as punishment.  I rebelled against that system, got teachers fired, tried to fight in little ways.

Growing up I had a 9 PM curfew in my senior year of high school.  Why?  “Because I said so.”   Not having any choice made me feel forced.  I became more a wild child from 18-22 years old.  I worked hard to get good grades.  It was a challenge.

I guess these joint pain explosions do occur when I do get stressed.  It tends to happen in the Fall and the Spring.  It starts with things tightening up, then full blown flaring with swelling and heat and sometimes redness.  The joint pains are burning, aching like a toothache, swollen.

(Looks like the process of the arthritic flares in the joints is trying to release huge energy: “explosions do occur”, “full blown flaring, with swelling and heat.”  So we see all the suppression is needing to find a vent somewhere in the system and the joints act like one of the pressure release valves of his organism.)

I have Psoriasis of the scalp, which I control with Selsen Blue.  My eye gets red and stings with the shingles.  I use prednisone for that and the arthritis, which works great, but it damages so much.  My blood pressure hangs around 180/100 without treatment.

I was married one other time.  It was a cavalcade of things. The divorce was gnarly.  My eldest son in that marriage is estranged from me.  He was tainted by his step-father. He sent me a scalding letter.

When he distanced himself from me (his son) is when I played really hard, too, and hurt myself a lot. Crashing and burning in mountaineering, flying over the handlebars when mountain biking.  I broke my collar bones.

I kind of barfed it all out there…didn’t I?

I meditate to make my pain go away.  Things are good for me.  I have a great life.  I am financially comfortable.

I never shot a gun.  Not into violence of any kind.  The state of the world right now has me, the human race—I feel horrible how people lose voting rights, women lose choice, democracy is going away.  It gets to me…watching our earth crumble, people on social security losing it all.  It really gets me, it hurts.  I feel sick to my stomach.  Throwing up at the audacity.  Physically it nauseates me.

(Here’s more of the barfing, forceful release of energy, leaving him “sick to his stomach”)

So unequal, so unfair, so wrong.   So angry with all the voter fraud.  Flush, flare, then done.  Grit teeth, clench fists.  Used to get on my bicycle and ride.

(There are many images of heat and pressure and holding in or back: “flaring”, hypertension”, “scalding”, “grit teeth”, “clench fists”, “flush.”)

I like salty nuts, salt and vinegar chips, sauerkraut.

I work in the automotive industry.  Restore cars and sell them.

I have this reoccurring nightmare about seeing a horrifying plane crash.  I wake heart-thumping and sweaty.

I shy away from confrontation or just take it.  I turn into sheetrock and just take it. I feel soiled inside, the anger and the resentment I hold inside doesn’t feel good or clean—push it aside.  I don’t want that part in my life.  I want to have choice.  Don’t want to carry the memories and thoughts of lack of choice, freedom, honesty.  Don’t want to be stifled, have someone’s thumb on me all the time.

(Theme of suppression and not having choice is again highlighted.  We need to understand what his organism is telling us.  At the end of the day, whatever remedy we give has to help him overcome the feeling of being “stifled”, like having someone’s “thumb on me all the time.”)

I’m a real dog person.  I really love dogs.  Never been a cat person.  My golden retriever was my truly best friend.  There is that unconditional love, loved to do whatever I do—peaceful, gentle, kind.

(At this point, the narrative ends.  I feel the case is clear.  There is little left for me to ask.  After explaining a bit about the process of homeopathic treatment, I asked him how best to reach him once I decided on a remedy.  He replied, “I’ll have my phone in my grubby little paw.” Here ended his appointment.)

At this point in my approach before thinking about symptoms, searching in the repertory and trying to find a remedy, I teach my students to first come to a clear and concise understanding of the case.  This step seems both vital and essential, as the ultimate remedy selected should closely match the basic “feel” of the case, in all of its most important facets.  Also, the effort to come to a clear conception of what needs to be cured, is what enables us to envision the direction of cure, against which the action of the remedy can be assessed in follow-ups.

For this case, a synopsis may look something like this:  our patient is a sensitive and gentle man suffering from hypertension, psoriasis and presumably psoriatic arthritis, characterized by explosive flares, and marked burning and aching pains.  In addition he also has chronic post-herpetic neuralgia of the left eye, which also is characterized by burning pains. Alongside his physical complaints, the patient suffers from significant and life-long emotional suppression, mainly of anger from longstanding domination. He is sensitive to injustice and oppression in the world at large, and describes strong emotional reactions to them, expressed in his rebellious nature and fighting for the underdog.  When ill, he feels like shit, nauseated, and even “soiled” inside.

With this working understanding in mind, the next step is to select rubrics based on the salient and most characteristic symptoms in the case, which are both central and unarguable. Selecting these symptoms maximizes the likelihood that the indicated remedy will be included in the repertorization.  Relying too much on artistic, psychological, and speculative interpretations of a case often results in a list of less grounded and less scientifically supportable list of remedies, and may result in missing the simillimum.

One common trap I see students fall into is the tendency to consider or look more closely at remedies that repertorize well—those which include all the selected symptoms and are listed in high degrees in the rubrics—rather than to objectively consider all the main remedies coming through at the top end of the repertorization.  Remember, the repertory is never the final arbiter in remedy selection.  One must always refer back to provings and materia medica. When a remedy covers a case well mathematically but lacks the deeper essential feel of the case, it generally falls short in producing the depth of cure we know is possible.

I cannot emphasize enough the role of developing a capacity for objective observation in case-observation, for the very reason that it is only a clear understanding of the patient in their disease that can lead us to which remedy shares the closest simile of the patient’s vital disturbance. All the strategies, systems, and philosophies rely heavily on this first step of learning how to clearly perceive, and knowing when one has actually captured the “gestalt” of the case.

Once we have developed our own capacity to a high degree along the lines of clear perception (Aphorism 3), and have mastered this fundamental skill of objectively observing a case, then the repertory alone, in a vast majority of cases, is a sufficient tool to guide us to the remedy required.  With good remedy suggestions in hand, our materia medica can deftly assists us in confirming which one is the true simillimum.

Coming back to our patient, there were many characteristic symptoms and some definite expressions that might be labeled “strange, rare and peculiar (SRP).  Some of the SRP expressions I found to be difficult to repertorize, so chose instead to focus on selecting rubrics that were most central and characteristic, saving the SRP symptoms as confirmatory qualities that should be part of the remedy chosen.  The following rubrics are the ones I used to solve this case:

  1. mind; ANGER; ailments from, agg.; suppressed
  2. extremities; PAIN; burning, smarting; joints (47) *
  3. skin; ERUPTIONS; psoriasis (153) **
  4. mind; LOVE; animals, for (33)

 

Other rubrics, which also related strongly to the central understanding of the case, were found in retrospect after choosing the remedy. They could be viewed as confirmatory or supporting symptoms of the remedy.  Here is a list of these rubrics:

  • mind; ABUSE agg., ailments from (78) *
  • mind; AUTHORITY, refusal to accept some one’s (39) *
  • mind; DOMINATION by others agg. (60) ***
  • mind; FORSAKEN feeling; children leave house, after grown up (1) **
  • mind; LOVE; animals, for; dogs, for (4) **
  • extremities; INFLAMMATION; joints, arthritis (210) **
  • extremities; INFLAMMATION; joints, arthritis; large (89) **
  • extremities; PAIN; violent (82) *
  • extremities; SWELLING; fingers (165) *
  • eyes; INFLAMMATION; conjunctivae, conjunctivitis (232) *
  • eyes; PAIN; burning, smarting, biting (496) ***

 

A repertorization of the first four symptoms selected above—the ones which I considered unarguable symptoms in the case—yielded the following list of remedies, covering either all four or at least three of the symptoms selected: Sulphur, Sepia, Natrum muriaticum, Carcinosinum, and Excrementum caninum!

Seeing the last remedy on this short list was initially a shock, followed shortly by a flash of insight and inspiration.  Admittedly there were many facets to this patient that might remind one of the remedy Lac caninum (the wandering joint pains, feeling of being dominated and demeaned, with low self-esteem, the psoriasis and anger), but that remedy only covered one of the rubrics selected.

At the time I took the case, I never even knew there was a remedy made from “dog poop”.  I knew nothing of its proving or symptoms in the materia medica, but when I saw this remedy in the list of possible choices everything lit up.  Here was a patient who, like Lac caninum, felt dominated and controlled all his life.  He felt like “shit”, always fought for the “underdog”,  felt “soiled” inside, had his phone at the ready in his “grubby little paw”, loved dogs to the point that his dog was literally “his best friend”.  From a scientific and more grounded perspective, all the additional symptoms listed were also covered by this remedy.  And, on some intuitive level, this case, for lack of a better, more scientific term, “smelled” of dog energy.

When science and art combine in the working out of a case, my experience confirms that the best results usually ensue.  Too much science, and the remedies that emerge tend to feel stale and often don’t take the case very far.  Too much art and the remedies picked may seem poetic, but they often land far afield, offering little help to the patient.

Our system calls for the blending of science and art. When we learn to incorporate both elements, we often get the most powerful results.  Connecting with more of ourselves, we become more open to resonate with the essence of things.  We participate more fully and directly in the sacred process of healing.  When this happens during the process of observing a case, we as practitioners also benefit from the experience.

I want to share this patient’s first follow up on this remedy and then his latest follow up a year and three months into the remedy.  He started on Excrementum caninum LM2.  (LM1 was not available due to the possibility of material substance still being present—yuck!). The remedy was sent blinded, mainly because I could not get myself to tell my patient what the remedy was made from.

Usually I support the patient’s right to know what they are taking, and feel it is unethical to withhold that information when the patient specifically requests it.  Fortunately in this case, the patient was fully trusting of his homeopath—like a dog to his master—and he was comfortable not knowing the name of his remedy.  I truly thought that his knowing it may have presented an obstacle to cure.

His first follow up occurred about six weeks after starting the remedy.  He reported no explosions or blistering arthritis attacks, which had been coming steadily for over 9 months.  He felt an overwhelming sense of calm.  “I am so much more at ease inside, less angry, a lot more open and receptive.  I am not riled up over anything. I don’t seem to have a bone to pick (notice the imagery). My meditations are so much more rewarding. More patient and my mind is not spinning wheels.”

His cheeks were less red, his blood pressure was somewhat lower than usual, and he had three nights of insomnia, which he used to have, but hadn’t had in years.  His fingernails and toenails seemed to be growing like crazy.

For me this first follow up was most promising.  The chief complaint was improving and the general mental/emotional state was definitely moving in a healthier direction.  The patient looked better and acknowledged feeling much better. Fast forward another year.  Here is what he describes now at his latest follow-up, having gone all the way up to an LM12:

“I am just loving life.  I am feeling so good.  No worries, no pain.  Didn’t catch the flu my wife had.  My hair and nails continue to grow like crazy. I am even needing to shave more. I can make a fist with my hands, which I haven’t been able to do for many years.  My eye is fine. I am off steroids, blood pressure meds, everything I used to take.  My blood pressure is normal, like 120’s over high 70’s.  I do yoga, exercise more and eat well. I’ve lost over 50 pounds.  My scalp is clear of psoriasis. My anger issues are so much less. I still occasionally get some joint pains, but they are only a shadow of what they used to be, and they hardly last long.  I am never limited by them like before and they are much less frequent.  My marriage is better than ever.   We are having so much fun. And, my estranged son from my first marriage has recently contacted me and wants to get together.  I am apprehensive but glad.”

So here we see that the remedy is in the process of bringing about a wonderful cure.  In context, it is following Hahnemann’s ideal of cure: rapid, gentle, and permanent. Along the way, this patient has experienced some ups and downs in his symptoms, but the long-term trends are all positive.  On the whole, this patient is experiencing the kind of transformation on all levels we have come to expect from the simillium. I am confident that, with time, a complete cure will result from this interesting remedy.

To be honest, I still cannot get myself to tell the patient the source of his remedy.  Instead, if and when he asks, I will probably put on one of those “s–t-eating grins” and respond with, “maybe we should just put that discussion off for now, since you are doing so well, and isn’t that what really matters anyhow?”  I hope he doesn’t press the issue, for his sake and mine!

About the author

Douglas Falkner

Douglas Falkner

Douglas Falkner, MD, MHom is the Founder and Chief Instructor at The Falkner School for Homeopathy, which offers practitioner training programs at both beginning and more advanced levels, all interactive, live and online. Dr. Falkner is a fully trained Emergency Medicine Physician, Clinical Emergency Medicine Instructor, and Homeopath. With extensive training in both conventional western medicine and homeopathy, Dr. Falkner combines his knowledge of modern medical science with a deep understanding of the homeopathic healing art. He maintains a busy homeopathy practice in Ashland, Oregon, and also offers phone consultations nationally and internationally. For more info: drfalknermd@gmail.com and www.thefalknerschool.com

6 Comments

  • Dear Dr. Falkner: Really fascinating and enjoyable case about a rare remedy and how you doggedly (no pun intended!) stuck to the classical approach and connected the patient’s language and symptoms to arrive at the Simillimum. Your method shows how important it is to use the minimum symptoms of maximum value and see the forest and not just the trees. But I do have some questions about the remedy itself. I had always thought, read and learnt that any part of an animal when made into a remedy carried the same energy. That is, the milk or tissue or hair or fur or feather of the same animal when made into a remedy has the same essence. So, why would the remedy you used in this case carry a different essence than Lac Caninum. (Note: Lyssinium while made of the saliva, is different as it is canine saliva tainted by the rabies virus). Anyway, this opens a whole Pandora’s box. We have Lac Felinum, Hawk, Salmon, Apis Mel, Tarentula, Naja, Lac Leoninum, Bufo etc but we have not potensized all their evacuations whether it be their sweat, tears, moulted skin, urine, saliva and so on. How far do we have to go in making remedies of these by products and proving them. As it is the Materia Medica has expanded (nay, exploded) with countless insects, dinosaurs, worms, mobile phone etc potensized into remedies. (I am not kidding here, these remedies exist. I may need to use a Seeing Eye dog just to guide me through the maze that the Medica & Repertory have become today). My second question is, is the remedy that was used really an essence of the bacterial flora that resides in dogs. Almost like a Bowel Nosode from the canine family. I would hate to think that the remedy is instead only a potensized end product of digested ‘Kibbles’ or ‘Purina’. Please don’t get me wrong. Your case was brilliantly taken. You identified the ‘red line’ that ran through the entire patient from head to toe (or head to tail in this patient’s case) so intelligently. I tip my hat off to your deductive reasoning and your humility in choosing this available remedy and then allowing the vital force to take over. Not to mention your absolute gentlemanly conduct in not revealing the remedy to the patient to avoid hurting his sensibilities. Your professional conduct has been exemplary, brilliant and inspiring to the rest of us. But I want my Homeopathic brothers and sisters to critically self examine how far are we going to go with preparing remedies, do different by-products of animals carry significantly different energies to warrant making remedies of all of them and so on. The venerable Kent at one time stopped propounding his synthetic remedies. I hope I didn’t stir up a hornet’s nest by my comments, but I have been an ardent disciple of homeopathy for many, many, many years and sometimes I wonder where our Science is heading. In the good Dr. Falkner’s defense I would say – “The remedy worked, it cured the patient, does anything else matter?”. Thank You Dr. Falkner for this wonderful case. I remain, a fan and admirer of your classical methods. In conclusion, I can’t resist praying that the patient is not a subscriber of Hpathy, because then he would read the article and figure out his remedy. And then the cat would be out of the bag, my friends. And dogs and cats don’t really get along – or do they!!. Thanks

  • Dear Dr. Falkner & Friends: As a footnote…..Nature loves exceptions and throwing a curve-ball when least expected. Later, I realized that ORGANOPATHIC remedies are probably an exception to the rule that all healthy tissue from the same animal when potensized carry the same energy. I have used organopathic remedies very rarely, so I am not an expert on them. But, in retrospect, they could all (liver, lung, heart, brain etc) be made from the same species (or animal) but have different therapeutic applications and energies. But my point is that if our Homeopathic Community makes endless remedies out of “the Eye of the Tiger, The Lion’s mane, a Snake’s Rattle, A Bear’s Claw, A Crocodile’s Tears and so on”……the Materia Medica would explode beyond comprehension. We should certainly prove and keep remedies for each species and class/sub-class and their milks. But making remedies out of endless by-products – urine, sweat, tears for each species, class, sub-class and so on will create a logistical comprehension nightmare. I don’t want Homeopathy to go the way of Latin (a beautiful language) but difficult to learn and it ultimately fell into disuse in the light of easier languages that came along. I apologize if I have hurt anyone’s feelings. Thanks.

  • Dear Friends: If you are reading this page, let your primary focus be on Dr. Falkner’s case. The patient, his central theme, the remedy, the cure and the doctor’s classical method…..is the lesson to take away. Yes, I hope my digressed comments and academic thoughts stirs some homeopathic introspection among all of us regarding the future of Homeopathy, but the “Dogged Case & the Cure” by Dr. Falkner should be what you walk away with, the mission that was accomplished, the tune left playing in your mind after the concert ended. Respected Dr. Falkner, continue to publish and send in your many cases, so we, the readers, like simple but loyal Watsons, could learn from Sherlock. Good Wishes, Philip.

  • Glad you wrote this, Douglas! I have a similar problem and think, its good, that you didnt tell. Its so good to hear that it worked so well, then. I can say I had difficulties trusting, but I go try also…

    Id love to know what where the hints that led you to the remedy? just the main ones, if you like to share …

    TyiA

  • ps: I did read the proving…, so am aware of the proving main aspects, just asking, which/what made you think of it?
    best wishes
    C.

  • pps: sorry, I missed parts by scrolling and now found all answers myself… I can totally see it. So its juts thank you, I give it a try, too.
    C.

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