Interviewed in the Student Clinic of NYSH; a case analyzed using big ideas and the repertory.
The case was initially taken by Helen as a 4th year student homeopath, and supervised by Susan Sonz. The patient’s name has been changed.
Several short forms or punctuations might be used throughout the case. This NYSH legend below explains their usage.
M = The client
CAPITAL LETTERS= The homeopath’s questions
My comments are in [square parenthesis]
HG = Hand Gesture
SD = Spontaneous Denial
Bold Indicates significant statements made by the client
CONF= confluence or repeated idea
CC. Facial Acne and Hormonal disturbance
28 yr old Monica came to our clinic on 27th September, 2008, seeking help primarily for severe facial acne. She was a full time employee of a respected University. She was also a full time Masters’ student at the same University. Monica is an overweight African American woman with a round face that was rather swollen, a large wide nose, and very large breasts. Her entire face was covered in small raised pimples. There was an obvious redness and inflammation that periodically flared up and then calmed down throughout the interview. Monica had a history of teenage acne, but said her skin was a lot worse when she came to the clinic than it had been in previous years. She had been taking the antibiotic Doxycycline for the last three years and also used the topical ointment Tazorac, both of which she agreed to stop before taking the chosen remedy.
The most noticeable thing about Monica was that as soon as she walked into the room, she began to cry and continued to cry throughout the entire two and a half hour interview. I began by asking Monica why she was crying. This involuntary and public weeping was striking and, in terms of observation, the most prominent symptom.
CAN I ASK WHY YOU’RE CRYING?
M: Because I always cry, I’m emotional. Lots of people here…Maybe questions I’m not ready to answer.
DOES ANYTHING COME UP RIGHT AWAY?
M: Two or three years ago when I graduated from college, bumps on my face. Hormones made my acne go into overdrive. Stress – going through a lot of changes, graduated, what would I do next in my life? Busy this year, same things happened to my face. Sister came out to my family. Starting a business. Started graduate program, full time, along with working full time. I was in two weddings this summer, but had no money. All this caused skin stuff to manifest again. Questions related to my sister’s coming out.
My father’s been absent for a long time, but he’s asking for me. I tried to avoid seeing him, but I’m trying to seek love, makes me emotional. Differences in interactions with females and males. Mom is a single mom; she lost her job because of the economy.
WHAT ABOUT THE STRESS?
M: May, 2004, was when I graduated, I had a clear face one night, then I woke up and there were all these bumps. It must have been something I ate, so I took Benadryl. Dermatologist said meds wouldn’t work unless I got the stress under control. After 3 months of meds it went away. Without meds in the morning it was not bad, but during day it starts to flare. Except the first time, then I was fine when I went to bed, and woke up and it was bad. Now when I start to wash my face I feel the bumps and later in the day I start to see it
TELL ME ABOUT THE STRESS?
M: I was going thru a lot of changes, graduated, wondering what would I do next in my life?
WHAT IS YOUR EXPERIENCE OF CRYING?
M: I cry a lot. Almost anything triggers it, I see that.
HOW DOES CRYING MAKE YOU FEEL?
M: It takes a load off, I don’t have to hide.
WHAT IS THE WORST THING ABOUT YOUR SKIN BREAKING OUT FOR YOU?
M: Besides the way it looks, it’s the way that it feels; so many bumps, on my cheeks, and [motions to] forehead. I can’t hide it, it’s all there, people are looking at it. I make a joke to others, ‘You must be counting the bumps on my face.’ Hormones made my acne go into overdrive. Now that it’s happened again, I know I’m at that place again, where I was 5 years ago.
The dermatologist said the other day the stress is in the subconscious. I can’t control what’s already manifested on my face. It’s like a contradiction to what I really want to do, a complete opposite. I can’t control it. It’s like that place where I’m trying to feel again. I want to be in a place where it doesn’t affect me again. Maybe my face is trying to indicate to me that I’ve brought myself to that place again.
Like a punishment again, if I’m trying to be Ms. Fix-it.
[She reported that clumps of hair fell out when she brushed it, although there was no visible sign of alopecia. She had downy facial hair covering her cheeks and visible facial hair that had grown in front of her ears and a few centimeters down the sides of her face, which was worse on the right side. Both her upper eyelids had a weakness to them with a slight drooping. She had bloating and breast tenderness prior to her menses, heavy menstrual bleeding and a very regular cycle on the 19th of every month.]
M: I can’t wear tampons because I’d have to change them every 20min. Clots are bright red.
DO YOU HAVE ANY SYMPTOMS BEFORE YOUR PERIOD?
M Breasts are tender, no cramps. Get it around the 19th of every month.
M: Sex is non-existent. I’ve only had sex twice in my life. [She talks about this in a very clinical way.]
THE TWO TIMES YOU HAVE HAD SEX, WAS IT ENJOYABLE?
M: Yes, first time, because I knew him, but the physical part of it no. I decided I would have sex with him because I knew him.
[Monica suffered from anxiety and a nervous kind of excitability. She talked a lot about this during her interview and also talked about insomnia due to her anxious state.]
M: I applied for a grant, I wasn’t sleeping, waiting to hear. I was so anxious, excited, in a nervous way, impatient, edgy. When I go to that place the face erupts. I was anxious about graduating. Warm heat rises to my face. [She was generally hot] An anxious state, I don’t sleep much. I am always awake, tense, my body is tense. I get tense in my back. I need to relax. I listen to my i- pod but I can’t fall asleep.
M I love chocolate – if I’m around it everyday I would eat it and I can’t stop.
This case was clearly a very hormonal one; her chief symptoms were:
Downy hair on face < right side
Generally hot and heat rose to the face
Incessant weeping throughout interview
Painful breasts prior to menses
Bloating prior to menses
Menstrual bleeding heavy and bright red with clots (no pain and very regular)
Craved chocolate. < Chocolate.
NOSODE OR SARCODE?
- In clinic we have learned that if a patient speaks mostly of their illness, or an organ, or a specific part of their body, (or in this case hormones), the best remedy at the moment may be a nosode or a sarcode.
- A nosode is a remedy made from a pathological specimen.
- A sarcode is a homeopathic remedy that is derived from healthy tissue or a healthy organ.
- When prescribing a sarcode, one expects to see symptoms that are centered around that specific organ, organ system, or in this case, a hormone. We saw all of Monica’s symptoms revolve around her hormones as seen in the list of key symptoms.
- A sarcode will present a very physically based case.
- A strange and peculiar symptom was that her chief complaint changed in front of our eyes; the pimples periodically became very angry looking and red, only to become significantly less inflamed.
Hormones themselves are regulatory substances that control how cells and organs do their work. They essentially help maintain balance throughout the body. Balance and control are central feelings in the hormone remedies, both of which were central issues in Monica’s case.
Everything about Monica was off kilter and out of balance. Proportionally she was also out of balance; her breasts were very large in comparison with the rest of her body. Monica talked a lot about balance in relation to her life in general.
She talked about always being there for her friends and family, being a good listener and putting others first. She described herself as being the one who fixed others problems, talked about being the “glue” in terms of her family and the one who brought balance.
“I am the backbone of my family. I am overwhelmed, I am the only one being the provider, emotional, even if not monetary, I bring balance to friends and family, I play this role.”
Control was a major theme in this case and one that is clearly akin to Folliculinum as well as the Cancer Miasm and Carcinosin in particular. Carcinosin and Folliculinum have a very similar remedy picture in terms of control.
This case seemed to be clearly showing the energy of the Cancer Miasm. The energy of her problem was about control and her instinct to do things right.
Monica spoke about dancing and said, “I love it, all I did was salsa. I love it; I’m really good at it. It makes me feel happy. I like moving, I’m in control again. I am always in control when I am dancing.”
HOW DOES IT MAKE YOU FEEL- HAVING ACNE?
M: When the bumps come out it is my indicator that I am trying to control so much, trying to be Ms. Fix-it, trying to have it all together when I really don’t. I can’t control what has manifested; it [the acne] is a contradiction to what I really want to do… keep it together. I was trying to hold this control, this place that broke down, to control everything, to look stable.
M: I just remember when we didn’t have anything…[Sobbing] I see the control phase.
HOW DO YOU PICTURE YOURSELF IN THIS CONTROL PLACE?
M: Suffocated, I can’t hold it all together. Dark, sad, I can’t sleep. It is a dark situation.
Monica talked about always having to be there for her Mother and having to keep everything under control in terms of looking after her.
M: It is a chaotic situation, I have to have everything under control because she has just me.
This was an interesting statement as here we see both an expression of control and its opposite; chaos. This is a strong expression of the Cancer miasm.
Folliculinum Oestrone, follicular hormone.
Oestrone is an estrogenic hormone secreted by the ovary as well as adipose tissue. This hormone promotes the development of female secondary sexual characteristics, such as the breasts, and is also involved in the thickening of the endometrium and of regulating the menstrual cycle.
Monica’s initial interview directed us strongly to a sarcode. Not only did she keep going back to her hormonal issues throughout the case, all her symptoms were hormonal and she cried throughout the whole interview. The strange and peculiar symptom (her acne that fluctuated, inflamed and then retreated in front of our eyes) was also strongly indicative of a sarcode.
Once I began to investigate the hormone remedies, Folliculinum was an obvious match.
Not only does Folliculinum have control as its central issue, it also has excitability and depression, something that Monica clearly displayed. Hers was a kind of nervous and anxious excitability that often swung to a weepy and depressed state. Her hormones were out of sorts and out of balance. This was displayed in many physical ways, again indicating this remedy. Sadness is a keynote of Folliculinum and weeping a definite symptom of the remedy, something that Monica constantly displayed.
Another very interesting symptom of Folliculinum is that they are “addicted to rescuing people’ and this was also a strong thread throughout this case. Monica felt she had to be there for everyone else to listen, to be the glue, to be the backbone even though she found it very exhausting.
Julia Loos, MD, pointed out that Folliculinum displays quote “Overwhelming pressure or self imposed expectations.” Monica felt that it was her job to be there for everyone else, yet she found it overwhelming.
Below are the relevant symptoms listed in Vermeulen’s Synoptic II in relation to the case.
- Vermeulen states that one of Folliculinum’s leading symptoms is control
- Quoting the Material Medica, “She is out of sorts with her rhythms.”
- “She becomes a rescuer, addicted to rescuing people.” This is something that Monica does in her relationship with friends and family
- Excitability and depression
- Menstruation is heavy, bright red with dark clots
- Painful mamma before menses
- Pre menstrual symptoms
- Breasts swollen and painful
- Very low or high libido
- Generally hot
- Craves sugar
RX: 1 dose of Folliculinum 30c was prescribed 4/10/2008
Monica had been taking a tetracycline medication and applying medicated face cream prior to the appointment and stopped these before the remedy. She also stopped eating chocolate and drinking coffee, as it made her anxious.
Throughout Monica’s treatment, I kept up with her once every 1-2 weeks via telephone.
1 week later – phone consult.
As the week progressed Monica felt less excitable in a good way. She became more interested in herself and not in her friends problems, which felt good. This was an immediate amelioration in regards to the symptom of rescuing others. She sounded happy and bright. Monica said the initial interview was very healing.
She felt tenderness in her breasts slightly, which was unusual because she was not about to have her menses.
Her face felt better, it didn’t feel as warm. People commented that her face looked good.
2 weeks later – phone consult.
Monica continued to do well. Her skin was a lot better, less inflamed and not as many bumps. In some areas there was still acne, but it felt a lot better.
Her sleep was good. Before taking the remedy she did not sleep well, this was a major improvement.
Monica felt less jittery and anxious.
She also reported that her hair was not falling out when brushing it.
3 weeks later – phone consult.
Monica developed a cold sore. This was something she had experienced in the past. The cold sore was not as severe as previous ones, indicating a return of old symptoms.
Her overall mood began to decline; she felt sadness and also tired.
Monica repeated the remedy, at the same potency. She reported that she felt so much better after taking the remedy; very well rested, emotionally lighter and no longer sad. Her face continued to improve. The bumps were not completely gone, but there were areas of her face where she can see her skin versus bumps. The cold sore disappeared.
Monica talked of having a high libido which had not happened in a long time.
Every week her acne diminished.
Overall Monica felt great and very grounded since taking the remedy. She started seeing a therapist and was making a lot of progress in her personal life. She began sleeping beautifully and sounded very happy. Her anxiety was less and, although she had odd moments, she felt homeopathy “opened me up.” Her skin continued to improve. Although there were still bumps she felt she looked good.
Her energy was excellent even through final exams. She was under stress but handled it really well, a true sign of a good remedy. Her sleep continued to be great, again an important and significant amelioration. At this point, the clotting prior to menses began to improve also.
At around the 3 month mark Monica experienced a shift in her sleeping pattern and anxiety levels. She felt anxious and began waking very early. A repeat dose was given and this resolved all her returning symptoms. The anxiety went, sleep was great again and her skin remained stable.
3 months later – Follow up in clinic Jan. 24th 2009
She came in for a follow up interview and it was clear that Monica had lost weight. She came in with lots of energy and was quite cheerful.
M: I feel great. When I came the first time I was really anxious. I had this flare on my face with all these bumps. [Her face is remarkably better- both the inflammation and the acne are gone]. I took the Folliculinum and I felt so good to be taking something. My sleep was absolutely amazing. I don’t think I ever slept the way I did after taking it.
YOUR MENSTRAL CYCLE AND THE CLOTTING?
M: I just finished and there was not as much clotting. This cycle lasted 3-4 days. That’s less than my usual 6-7 days.
ARE YOUR BREASTS STILL TENDER?
M: Breasts are still tender. It’s the day before and it’s enough for me to know that they are sensitive, but the bloating has gone.
Monica had a bout of thrush, something she had experienced in the past, which responded very well to Folliculinum, clinical evidence that this was a great remedy for her.
8 months later – June 13th 2009 Follow up in clinic
Monica came into the clinic with a very bright and energetic energy. Gone were the tears, her skin was smooth and she wore a patterned dress with vivid color. She was generally more vibrant, happy and engaged. This was a completely different picture to our initial meeting.
Monica was doing really well. She had started going to a therapist, sought out a nutritionist and had an overall feeling of well being. Her skin looked great and she got a lot of comments about how good her face looked. Her hair looked shinier and she had obviously been taking care of herself in general.
Her cycle was good, still heavy, but no pain. Bloating was no longer an issue.
1 year later
As the year progressed, Monica’s skin was no longer a problem, her acne had disappeared and all other symptoms, the bloating, heavy menstrual bleeding and clotting, low libido and periodic alopecia were resolved.
Monica periodically re-dosed with 30c for returning feelings of anxiety and insomnia, both of which were relieved with Folliculinum. The remedy helped to bring her back into a state of health and continued to activate the healing process.
Folliculinum was a tremendous remedy for Monica in many ways. She had a very rapid response to the remedy. Over the course of 18 months we saw the remedy transform her by alleviating her physical symptoms and improving her overall happiness and general wellbeing. Not only did Folliculinum cure her inflammation and acne, it alleviated her anxiety and enabled her to sleep very well. She was no longer trying to “rescue others.” This was a definite sign that the remedy acted deeply. The remedy addressed a deep-seated emotional imbalance and brought her back to health in a profound way.
One question in a case like this could be, “Can a nosode or a sarcode be a simillimum?”
We have discussed this in class and theoretically we suspect that, even in a remarkable case like Monica’s where the sarcode was needed and cleared up a great deal of the case, it was very likely not the true simillimum.
Some evidence for this argument became clear when, as Monica’s presenting symptoms disappeared, she developed a blocked ear. Although Folliculinum helped alleviate this symptom, over the course of 18 months the blocked sensation in the ear began to develop into tinnitus and vertigo. This indicates that, although Folliculinum was extremely helpful in many ways for Monica, it was not her simillimum. In order to address this new symptomology, Monica would need to come for a new intake.
Unfortunately, Monica was reluctant to come in for a new intake. We assume it may be because she had been helped so much by Folliculinum that she may not have wanted to risk trying a new remedy. It is unfortunate because Folliculinum had opened up the case and cleared up so many of the problems, that her true remedy would probably have been easily revealed in a new interview.
Vermeulen Synoptic II
Samuel Hahnemann – Organon of the Medical Art
American Homeopath 1997
Murphy’s Nature MM
Mangialavori’s Additions 5 for KHA
Zandvoort’s Complete Repertory for KHA