Reprinted courtesy Petr Zacharias from : Case Quizzes And Clinical Hints For Devoted Students Of Classical Homeopathy – by Petr Zacharias© Petr Zacharias, 2017
Female 59 years with troublesome menopause. For the last year she has been suffering from very strong flushes of heat as if everything is burning up inside her body, together with cold perspiration, flushed face and loss of concentration. She started to use hormonal pills from her physician but although she feels a bit better, flushes of heat are still present. The flushes of heat come very suddenly (3) mostly during the day. These flushed are mostly felt in her face (she has red cheeks during each episode) and they are accompanied by perspiration of the face and red cheeks. She has cold feet constantly but does not need to wear socks. Six years ago her ex-husband at that time was unfaithful to her and she lost a lot of weight and had to work constantly to release her psychological state.
She feels as if nobody needs her and loves her anymore. It is very hard for her to accept her age as she used to be very attractive for men and now she feels as if she’s losing this. She wants to be alone, which is something very unusual for her. She has suicidal thoughts (2). All physical troubles started during climacterium. All her life she has had low BP. She totally hates tight clothing around her neck (3) and all her complaints are much ameliorated by exercising outside in the open air. It is something that makes her much better both physically and psychologically. When she is exercising in open air she has a kind of euphoria.
Follow-up after 5 weeks
Two days after the remedy, a kind of herpes developed around her lips and she felt as if her mouth is burning up inside. This lasted for two weeks and now it is getting better. Flushes area bout 10% better but they are getting better day by day and there are days without flushes at all. The suicidal thoughts have diminished completely and her mood is about 50% better. She feels much better regarding her energy and emotional state.
For me this was a very difficult case and my students who saw it in summer school a few years ago know it. I let the patient leave the class and then I said something like I don’t know,I have some ideas but none of them make me happy. My mind was oscillating between three remedies that have a strong relation to menopause because as we already know, all her troubles started during menopause.
The remedies I was thinking of were Amyl nitrate, Lachesis and Sepia. These remedies are closest to this case and for each of them there are some keynotes.The question is which of these remedies is uppermost. For all these remedies flushes of heat are a keynote but they differ a little bit from each other. So here is the difference of flushes regarding Amyl nitrosum, Lachesis and Sepia. Please remember that I want to show you the differences regarding flushes of heat but we need much more than this in order to prescribe a remedy as it is very dangerous to differentiate remedies on the basis of one symptom only.
Amyl nitrosum has flushes that affect the upper part of the body(face,thorax and shoulders) and they are sudden, very intense, quick and local, followed by perspiration. Local means for instance in face only.
Sepia has flushes that travels from below up as lot of symptoms in this remedy and they finally affect the whole body. The patient feels as if she is about to faint. They are chilly and often have low blood pressure.
In Lachesis flushes can begin in the face and finally affect the whole body. The patient is warm blooded and often has high blood pressure.
We should never make a final decision on the basis of particulars only, but if it comes to advanced differential diagnosis, they could sometimes be useful. We have to keep in mind that flushes are the main problem and such differences can help us when the patient´s symptoms are clear regarding flushes. In this case they are moderately clear as they affect the face only and they are followed by perspiration of the face together with red cheeks and they are sudden and very intense. This looks very much like Amyl nitrosum but there is a possibility of Lachesis as well, because there is a strong history of jealousy and the mental picture of losing attractiveness is quite characteristic for Lachesis patients. When you add a strong aversion to tight clothing around her neck, it seems to be quite a good choice. However, when I asked about reactions to the sun, she said: I prefer to be in the sun instead of being in shadow.It took my thoughts away from Lachesis back to Sepia and when I asked if there is anything that makes her better, she spontaneously said: “The exercising in open air makes me even euphoric“.
Now let me tell you something. When you suspect a polychrest to be indicated in a patient but you either cannot confirm it or some small details do not agree (patient is amel by sun which goes against Lachesis and we are not able to confirm Sepia as it does not have local flushes), think of a small remedy. The remedy in this case was Amyl nitrosum, which has both local flushes and strong amelioration by exercising in open air as a keynote. It has strong intolerance of tight clothing and they are very jealous like Lachesis. It can be very similar to Lachesis,especially in women suffering from climacteric flushes. It was given in single split dose in 200 C potency.