Clinical Cases

Heaven must be in me before I can be in heaven

A case where Coffea is given with differentiation among other remedies including Chocolate, Hydrogen, Cocculus etc.

Name: Mr. D. Age: 34 years

Chief Complaints:

  • Tremendous agitation and anxiety in the solar plexus, for the last couple of years. Right hypochondriac region, pain all the time. Tremendous pain. Tension, gnawing, as if snakes were in the abdomen.
  • Frequent urination.
  • No real appetite. Eats compulsively.
  • Negative thoughts, depression, lack of energy. No drive. Confusion of mind. Nervousness. “My circulation is blocked. Energy is blocked here in this area (points with a finger on solar plexus area). I feel burning, fire inside”, < stress3.
  • A lot of fears – death, anxiety, worry about future (Laughing).
  • I do things, I go out.”

Patient as a person:

Appetite: I don’t feel hungry. I eat when stressed. Food tastes bad.”

Desire: Fruit3, Salads3, Sour3

Eliminations:

  • Stool: Frequent. Soft.
  • Urine: Frequent

Perspiration: Profuse, chest3, forehead3.

Feet -offensive odor

Thermal: ‘I don’t like ‘heat’ more. I can’t tolerate it.’

Coldness of hands, a constant feature.

Body Language: Agitated, fidgety; closed; legs crossed, arms crossed; palm over solar plexus.

Sleep: ‘Sometimes a lot of ideas and thoughts make me awake for hours.’

Dreams:

  • Nice, pleasant. Paradise. Positive. Picturing the world, heavenly.
  • Mentally retarded child
  • If I wake up from a pleasant dream, I feel sad.’

Past history:

  • Hepatitis
  • Throat infections
  • Crustiness in ear pinnae
  • Past Remedies – anti-depressants

Investigations –

Liver function tests- nil

Renal function tests – nil

Blood sugar: Fasting and postprandial – Within normal limits

Family history:

  • Sister – Cancer – Sarcoma
  • Mother – Anxiety
  • Maternal Grandmother – Ischemic heart disease
  • Paternal Grandmother – Dementia

Life space:

  • I was born in Canada. I don’t have any memory of it. Distracting memory. My mother brought me up, in a traditional home (not very strict). I was 5 years old when my father was murdered. Real Estate in Canada. He found out about some fraud and he was killed. I moved here in Canada from India. Then my mother approached one meditation center cum school in India. My sister got cancer and she died when I was 10 years old. She had sarcoma. At 10 years, I went to India with my mother to the center and lived with a spiritual Guru. People liked me, but I was shy. I got spiritual training at the center and I became a yoga teacher there.
  • I would love to feel emotions – love, crying and ventilation. I’m in a box. I love growing things in the garden. I want to focus on the garden. I like the beauty of nature than the city life. There is a war situation in our country.
  • I want to get a remedy which will relax me. I need the mental calmness. My dream is to be relaxed. I experienced tranquility with Yoga and meditation.
  • Pressure of life started here at Canada. I was in a village in India from the age of 10 years to 28 years. I grew up with older people in India and now I was like a new child in Canada. Stressful. The world needs to be saved. Spiritually minded. Philosophical ideas. Kabala. I am married and I have a son. Tough relating to family. Not open in intimacy. The world; I don’t like as it is now.
  • I liked Himachal Pradesh. I lived a sheltered life in India. I didn’t go for formal education. I did a correspondence course in Hindi and English.
  • Guru – Different state of consciousness. Nice community. Not any future. I wanted establishment for myself. Guru’s training – soul, immortal etc. It helped me to forget the grief that I sustained. Now it is really returning back. The Western world I experienced in terms of competition, violence etc. Hence I like going to an Indian village. The Guru was with me – good; affectionate; complex. Role model – freedom, joy. The Guru’s son suffered a lot, he became mad; schizophrenic – delusion of paranoid. The Guru was not an image of a stable family. He had some family problems.
  • Conflict. Irritation. Doubt of self. Idealism. Dependent. Vulnerable. Confusion – I have all of these. I don’t know where I am. I can’t see what is going on around me. I am scared I will lose my reason. Avoiding life, conflicts etc. Now it is hard for me to accept modern life (laughing). It’s a step by step linear process and it takes time to adapt.
  • I can’t focus since the last 2 years. I have the ability to teach. Now my brain is shutdown. I want to be ‘relaxed’. I am teaching Yoga. I am gardening. I get little money. I am resentful about it.
  • My mother was there, friends were there. I had a feeling that there would be a training institute here in Canada.”
  • Relation with brother: Has one Brother-Active and he is married.
  • Relation with mother: Mother – pushy, strong and involved. Manages own her own. Finds her own way. I fear severing my relations with mother.
  • Relation with wife: I met my wife in India in the village. We married in Canada. Wife- Demanding, strong. She has a job. She has boundaries. We have one son of 6 years old.

I am involved in myself.’ ‘Cold’ relations between myself and wife. I have to follow her now. I check everything with her. I take things on myself. I feel guilty. I wanted a child, but wife didn’t want one. I wanted to raise my child in India.

Questions

  1. Define the dispositions of the patient.
  2. What have you to treat in this case? What is to be cured?
  3. Derive the appropriate rubrics.
  4. Arrive at probable remedies you want to propose. Give reasons for your selection.
  5. Explain the differential world of materia medica pertaining to this case.
  6. What is the final remedy according to you and why?

Data Processing

This is a psychosomatic case. The investigations are normal and we are able to see the travel from the mind to the body in terms of sensations, feelings and emotions, dreams and delusions and behavior.

The family history is suggestive of syphilitic preponderance but nothing is represented by the system either at a physical or at a mental level. The past history is of two infections – hepatitis and throat infections but they have not gone into any chronicity. Liver function tests are normal. Hence chronic hepatitis as a sequel to childhood hepatitis is ruled out. In the absence of diabetes, frequent urination can be linked only to the mental state.

The following chart deals with human symbolic language. The two organs liver and bladder represent some themes and they co-relate well with our patient’s mental state.

The patient experienced two big events in the phase of childhood – murder of his father at 5 years and death of his sister at 10 years and then subsequent life in India from 10-28 years old. The harsh and violence side of life was an experience for a sensitive boy who was then posted in an opposite field of spiritual life under the umbrella of his mother. It is to be remembered that one should not pick up the rubric of ailments from grief as an emotional causative modality as the patient is not stuck in grief now but in other “fields” being created by the self in life continuum. Further, the memory of grief has not been reinforced by the patient and it’s not the issue of frozen bereavement. Actually, healing was necessary for his mother and she tried to resolve her grief through the spiritual pursuit.

The spectrum of adolescence and early adulthood has been passed in an Indian village with no formal school training but in a spiritual school. There is definite mundane deprivation which has played a vital role in the personality development of this individual. Adolescence life is characterized by the world of actualization and the world of abstraction. The equilibrium between the two goes for a balanced, mature ego development. This patient is impressionable and has no identity of his own. Neither deductive nor inductive thinking has been developed and this has gone for immature ego development and functioning.

The sentence “I want to change the world to bring tranquility” comes from the spiritual training of many years. The value system developed due to training allows him to think of noble deeds. But what matters is “Is he capable of doing this?” The resources at intellectual level are less and we are, hence, able to see the non-adaptogenic behavior. He postures himself as unable to accept the modern life. The stress over ego functioning is apparent. It is not identity crisis. It has not yet culminated. The state is more of a naïve person who wants to shun violence in the World.

What ails this person? Is it the childishness to be treated? Is it the confusion of identity to be treated? When we will analyse from our subjectivity, it is likely that we will miss ‘what is to be cured’? The patient begins the history with ‘tremendous anxiety and agitation in solar plexus’. The solar plexus is a complex network of nerves and is formed (in part) by the greater and lesser splanchnic nerves of both side and also parts of the right vagus nerve. It is composed of both grey and white substance and it receives and distributes nerve impulses to all of the abdominal organs and supplies the main organs of nutrition. It performs most of the important jobs in the so-called “vegetative life” of the body, supplying the nerve-energy which is required for nutrition, growth and assimilation. Dr. Byron Robinson called the solar plexus the “abdominal brain” in view of its capacity to act as a brain of lower organs. In Yoga, it has been termed as the third chakra and it has a function related to personal power, control, social identity, influence, inner harmony and joy. It is the place where thoughts, opinions and judgments originate. It can become excessive or deficient in function. When excessive in function, it causes aggressiveness and scattered thoughts and when deficient, low esteem, weak will and passivity. While pointing a finger on the solar plexus, he says that energy is blocked in the area. As a matter of fact a preponderance of “abdominal brain” over cerebrum and cerebellum is obvious in this case.

To answer the question ‘what is to be cured in this case’, we need to focus on his needs. It is here that we are able to understand him in a better way through the dreams. Dreams are – nice, pleasant, paradise, picturing the world, heavenly and he writes that if he wakes up from a pleasant dream, he feels sad. “The paradise feeling, the heavenly feeling should be the constant phenomenon. The answer to my sadness is to have this feeling”. The words “tranquility, I want to be relaxed, my dream is to be relaxed” are a facsimile of what he is representing as a sycotic miasmatic disease.

Rubrics

  • Impressionable
  • Impressionable, pleasure, to
  • Confusion of mind
  • Sensitive, moral impressions, to
  • Deeds, good deeds, desire to perform
  • Anxiety, stomach, in

From Dr. Ajit Kulkarni’s Body Language book ‘Clinical Repertory of Body Language’

  • Laughing, causeless, easily: aether, agath-a., arg-n., arn., ars., bar-c., bufo, calc., cann-i., carbn-s., carb-v., choc., coff., dulc., ham., lac-del., nat-m., nept-m., podo., positr., puls., sacch-a., sal-ac., sal-fr., stram., syph., tab., tritic-vg., ulm-c.

Result of Repertorization:

  • Coff -5/7 Puls-4/9 Chin-4/6 Staph-3/5 Positr-4/4 Ign-4/6 Cocc-3/7 Sep-3/5 Ars-3/7

Cic-3/5 Phos-3/4 Hydrog-3/5 Op-2/5 Aurum-2/3 Sil-3/7

Final Selection

  • COFFEA CRUDA

Why Coffea?

From T.F. Allen’s Encyclopaedia of Materia Medica

  • Lively fancies; full of plans for the future; contrary to his custom is very much charmed by the beauties of nature
  • Anxiety and unsteadiness
  • Great anxiety, so that she doesn’t know what he shall do with himself
  • Full of care; lachrymose mood
  • Sad thoughts

The following rubrics are also covered by Coffea

  • Dreams-pleasant
  • Feet, perspiration
  • Coldness, hands
  • Confusion, knows not where he is
  • Loves, nature
  • Anxiety, conscience, of

The Doctrine of Signature

  • Source information: The coffee plant has become a major source of oxygen in much of the world. Each hectare of coffee produces 86 lbs of oxygen per day, which is about half the production of the same area in a rain forest (source: Anacafe).

Remedy in MM: As far as basic elements are concerned, air principle is dominant in Coff. This is the reason why Coff. has ideas, imaginations and fancies more in its proving. Coff. is for exhilaration which one receives when adequate and pure oxygen is available.

  • The roots systems are heavily affected by the type of soil and the mineral content of the soil. To be thick and strong, the coffee roots need an extensive supply of nitrogen, calcium and magnesium.
  • Remedy in MM: Coffea as a type is dependent and unable to take a decision. It has less will power, less drive and motivation and can’t be dictatorial in life.

Differential Materia Medica

Chocolate

  • If coffee is called as an ‘oasis’ for the madness of modern man, chocolate may be called as ‘exhilaration’ for the madness of modern man. Chocolate contains caffeine, phenylethylamine, theobromine and theophylline. Both Chocolate and Coffea are vulnerable but Choc. is more conscious of self. Choc. has a more estranged and rejected feeling. Chocolate develops aversion to company in evolution while Coffea maintains its need of intimacy. Chocolate is sarcastic and takes joy in mocking the people. It can be cruel too. This is almost lacking in Coffea. Coffea is for naïve and immature people who don’t know what they want in their life. Choc. and Coffea are opposite in the sense that Choc. is selfish and even a social and antisocial also. While Coffea is selfless, it is after noble deeds and social ones also. Choc. is characterized by emotional highs and lows whereas Coffea is ecstatic and full of ideas, Choc. is slow to act while Coffea is quick to act.

Hydrogen

  • Hydrogen is also for confusion of mind and difficult concentration. It is not only for overcrowding of thoughts, but also for disjoined and jumbled thoughts. Hydrogen has strong alternations of moods, highs then lows. Hydrog. feels like a crippled old man, vulnerable, insecure and self doubting. It becomes progressively introvert and develops self-pitying. There is much more distortion of reality and feels disturbed and separated from the things. Should I say that if Coffea maintains its sweetness, it can go into the state of Chocolate and if he goes with bitterness, he develops the state of Hydrogen.?

Cocculus

  • Both are hysterical, anxious, and sensitive. But the themes are different. Cocc. produces spasmodic and paretic affections while Coffea produces nervous excitability. Cocc. goes to slow comprehension and stupidity. Coff. is quick, hurried and capricious. Cocc. mind is benumbed with profound sadness, while Coffea projects nervous agitation more than depression.

Pulsatilla and Coffea

  • Both are hysterical, impressionable and sensitive. Puls. craves sympathy while Coff. resents sympathy. Puls. is more childish than Coffea Both are religious, but Puls. more as a victim. Puls. is selfish, while Coff. is benevolent.

Opium and Coffea

  • Both are dreamy and have exaltation of the mind. Opium is courageous, Coffea is not. Coffea has anxiety of conscience, Opium has not. Both make gigantic plans but hardly make them to success. Opium is deceptive, Coffea is not. In evolution, Opium can go for complete insensibility.

Silica and Coffea

  • Both Silicea and Coffea are conscientious, sensitive and impressionable. But Silicea has more say of his own than Coffea Both resent sympathy. Sil. has more fixed ideas and obstinacy than Coffea As compared to Coffea, Silicea is more serious and deeper acting. Coffea has more the theme of joy. Remorse is covered by both but Sil. withdraws more than Coff.

Plan of Treatment

Coffea 1M, a single dose

Posology:

In view of high sensitivity, functional zone of illness, psycho-somatic reflection, high potency and infrequent repetition schedule

Follow up

First f/u after 3 months:

I am feeling a lot better. I took the remedy and since then have had lots of relief. Thanks for your wonderful remedy. I took your advice and got working and active.

Since we met a lot of great things happened. I got a job that really lifted my mood. It is in an organic ‘CSA’ farm right here in the village, that I live in. Now I am really getting excited about life and the new baby. I will just strap it to my back and head out to the field.

For years I grew my own personal garden, which I loved to do, but still an element was missing. That element for me was working with people. So I joined an organic farm which does home deliveries of organic fruits and vegetables all over the country. I work in marketing and out in the fields. For me this is a perfect combination of my passion for people and for the land. I enjoy the Yoga teaching, but I feel like a lone wolf, always having to promote myself. Having a job in organics gives me a chance to discuss with other people a subject that is close to my heart.

I am feeling much better. Now, the world isn’t that bad. The emotions are flowing and there is a lot of love for Tal and Manu and the things that I have.

There are some symptoms remaining, but I feel they are clearing up and when I am happy I don’t really feel them. My digestion still isn’t excellent. I get itching in the anus due to haemorrhoids.

Love you and looking forward to meet you, Doctor – Mr. D.”

There are two more follow-ups and they also show good progress.

About the author

Ajit Kulkarni

Ajit Kulkarni

Dr. Ajit Kulkarni M.D. (Hom.) is a veteran homoeopath, an academician and a famed international teacher, known for his innovative ideas. Dr. Kulkarni has presented 70 international seminars around the world and more than 100 seminars in India. He is Director of the Homeopathic Research Institute, Pune, India. He is a prolific writer on homeopathy and his works include co-authoring Absolute Homeopathic Materia Medica, and authoring “Law of Similars in Medical Science”, “Homeopathic Posology”
“Kali Family and Its Relations”, Body Language and Homeopathy”, as well as 22 books in the Russian language. He received the Award of Excellence in Homoeopathy (2011), from the Post-Graduate Association of India, the ‘Homoeo-Ratna’ award (2014) from ‘Homoeo-Friends’, India, and the “Life Achievement Award”, (2018), from the Sontara Bhansali Charitable trust and Indian Homeopahic Forum.” Dr. Kulkarni has represented homeopathy on Bulgarian TV and gave an address at Kachare Classic, Erandwane, near New Karnataka High school, Pune. Visit him at his website: Website: www.ajitkulkarni.com E-mail ID: [email protected]

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