Clinical Cases

Inability to write, Ganglion cyst, Fatigue, Emotionally Labile

Written by Miroslawa Witalis

Dr. Miroslawa Witalis demonstrates a high level of skill in treating a case with multiple problems on both the physical and mental level.

ganglion-cystThe patient is a 49 year old woman, complaining of obesity, liver spots, ganglion cyst, and fatigue.  She is a midsize, robust looking woman with dark hair and eyes, broad-shouldered, heavy upper body, small head on a short neck, and long, thin legs. She walks and moves fast, with limb movements lacking extension whereby her body makes a locked-up impression. She speaks forcefully and fast.

Her case as given during her first office visit, July 15th, 2010

Patient’s report:

My main problem is that I cannot lose fat in my belly and breasts. Even when I get really thin and my legs look like two sticks, I still walk around with this fat tire around my waist, not to speak about my bosom. If my upper body would not be so short and stocky I would feel much better.

Another problem is that in the last 10 years I started to get those liver spots on my face and forearms. I get them from even mild sun exposure.  But I crave sunlight and never get sunburn. Those spots do not itch or change once they are there. I also have had this ganglion cyst (Homeopathy for Ganglion Cyst) in my right wrist for more than a year now. I think I am too young for having such problems.

My eyesight has been recently dramatically weakening as well. I have a great trouble driving at night or using artificial light – my eyes easily feel tired and my vision gets blurry, especially in the evening. I need relatively strong reading glasses now which is a bit too early I believe, especially, that there is no reason for it. I have never been a reader, and I spend almost no time on computer. I find myself extremely restless. I need frequent breaks and have absolutely no patience for any systematic, repetitive or ponderous activity.  My secretary does all my computer work for me.  I have an enormous trouble writing a simple text down, even a standard Christmas greeting. I do not want to look like a fool, so perhaps some stress slows me down as well, but I do not believe this is the main problem. I just cannot express myself in written words.  I hate ponderous activity.  When I speak, especially in a direct reaction to something, then the right words just shoot out of me. I need not to think in such situations to be always spot on, often funny if needs be. This is one of the things I am well known and respected for.

I have been a lead teacher for many years, now am also an executive director of a small private school for children with special needs.  I have several groups of children under my direct care, 15 teachers and educators to coordinate and supervise, constant interactions with parents, authorities and public, and as you can imagine, also countless conflicts every day to defuse and solve. I have to be quick, fair, level-headed and firm, and this also is what I am being appreciated for. It often costs me a lot of effort to be calm, as I used to be very volatile, and still am extremely contradictory in settings where I do not have to worry about what people would think about me. But I am only trying to help as people usually need to be told what to do. It is not my fault that I have a quick temper and immediately know what needs to be done.  The worst thing which truly exhausts me though is if I have to make so called prepared remarks, or write official reports. I just do not know how to do it.  I am good only at reacting immediately, especially to stressful situations.  I do not even know how I have the energy for it.  The truth is that I really feel terribly exhausted most of the time, also dissatisfied with myself, especially towards the evening.  Nobody knows it but I often cry in bed about how awful and ignorant I am. Although people seem to respect me, I sometimes think I should leave my job so that somebody more able could take over my duties.

I used to be terribly sick and weak for the first 6 years of my life – my parents were constantly worried, and many times afraid that I would die. All I know is I was all yellow for a long time – but I also have been getting strep throat and upper respiratory infections frequently. I was very thin, could not eat, was vomiting all the time, and was having terrible tantrums.  Once I went to the elementary school however, I miraculously recovered. What is left in me from that time is only my quick temper with some inclination to fits of anger, my famous fear of animals – I used to panic and run at a distant sight of a small cat or even a hen or a cock, and I still have this fear today to some extent – and my terrible sensitivity to cold and damp.  I would immediately get a cold upon even a mild exposure to those.

My diet has been terrible for most of my life. I love sweets and can eat inordinate amounts of them. I need energy. But if I work hard physically I would easily get hurt.  My upper body is very strong, but my legs are not – or at least I do not really know how to use them. Or it is because all my tendons are so terribly stiff, I cannot ever get my legs or fingers completely extended. They have always been somewhat flexed, even when I was younger. Maybe that is why my joints get easily injured when I dig in a garden or lift.  I once even got a transient but extremely painful paralysis from sciatica after a strain to my sacroiliac joint when I was digging in the garden in a pouring rain. My leg was paralyzed for 3 weeks and I remember it as the worst pain in my life.

These days, I get those apoplectic blood surges often, especially when I have more sweets or get distressed.  One of my friends told me once that my face then turns the color of a red Italian prune. But I never have hypertension except for those moments.  These events actually may get worse when I lie in bed.   On one occasion at night I had such a blood surge to my head, felt terribly weak and my tongue and one cheek got paralyzed for several hours.  By the morning I was fine except for permanent loss of much of my hearing capacity in the left ear. I think that sugar also makes my skin worse. I get infected pimples after that. If squeezed, they turn into indurate, infected cysts, which heal terribly slowly and leave those awful scars on me.

Avoiding sugar makes me somewhat less tired and constipated, but all other symptoms remain unchanged. My stool has always been rock hard, often to the point that my anus would fall out from strain. I am extremely thirsty, especially for cold water.

Initial assessment:

This woman came to seek relief from her obesity, fatigue, liver spots, and ganglion cyst. However, both her report as well as the physical exam reveal much more severe and potentially dangerous, chronic physical problems. There also is a significant amount of mental-emotional pain and limitations which need to be healed. Both physical and mental-emotional problems point to a structurally weak core, with the tendency to excessive and hardened reactivity to insults in isolated physical and emotional areas.

Repertorization of signs and symptoms pointed chiefly to three remedies: Ruta graveolens, Sepia, and Rhus toxicodendron.

Ruta graveolens

The hallmark of Ruta is the feeling of a paralytic weakness in robust, sanguine constitutions, paired with the combination of the tendency to strains of tendinous structures and eyes upon overexertion, often with painful paralytic sequelae, extreme sensitivity to cold and dampness, and formation of slow to heal, knotty, nodular conditions in injured or bruised parts – hard scars and cysts, thickenings, calluses, and ganglion cysts as well. There is a characteristic weakness of legs, combined with the tendency to significant contraction of flexor tendons in major and lesser joints.  There is a bilious and apoplectic tendency with rushes of blood and heat to head, without a permanent hypertension; liver spots; desire for light, with a weak and blurry vision in inadequate light; an extreme constipation with anal prolapse upon straining on stool, and a violent thirst for cold water. There is an aggravation from lying down.

Mentally, there is an extreme restlessness with numerous phobias, including fear of animals; significant difficulty in expressing thoughts in writing; and a strong quarrelsome, contradictory tendency, with much dismay towards others. Yet there also is the same feeling of dismay towards self, overcoming the Ruta personality in the evening. Very often, Ruta children are jaundiced or otherwise sick and weak, to gain some of the external robustness later.


Sepia combines great sadness, irritability worse in the morning and evening, indifference, contempt or aversion to the closest persons, censorious disposition with tendency to scold and intolerance of being contradicted with a major difficulty in expressing thoughts in written form.  Sepia is introspective and not always ready to talk; once she speaks, she does it in a hasty, exalted manner. There is much of heavy, dull weakness in Sepia, mentally and physically, with great intolerance to cold. There is an extreme, persistent constipation, with anal prolapse and hemorrhoids, and a tendency to pale brown or yellow blotches on the skin. There are frequent flushes of heat to head and face; however, they result from venous rather than arterial congestion and so lack the apoplectic quality. The center of venous congestion in Sepia is abdomen and pelvis.

There is much weakness in the joints, especially in the knees, with stiffness and difficult extension; however, there also is much restlessness and numbness in them as well. There are warts, but no other tendency to cysts in the skin or ligaments.  There is not much skin hardening; instead, the skin tends to be itchy, inflamed or ulcerative.  Sepia’s troubles with vision and eyes worsen in the evening but are accompanied by photophobia. There is thirst on some occasions but not as a general tendency.  Food cravings are multifaceted, with very predominant nausea, bloating and uneven appetite.

Rhus toxicodendron

Rhus toxicodendron is often considered a quintessential remedy for the combination of extreme mental and physical restlessness, stiffness, and pain in the joints caused by and aggravated by overuse, pustular skin inflammations, extreme intolerance of cold and damp – especially the outpour of rain – and often suicidal depression.  There is a weariness of the body; easy sprains and injuries that may cause paralysis, often one-sided, with tearing or burning pain; and usually are areas of numbness as well.  A tendency to apoplexy exists but is not prominent. Constipation alone is not characteristic; it rather alternates with diarrhea or even involuntary stools; there is no anal prolapse, instead hemorrhoids protruding after the stool strain.  There is no tendency to build nodules in ligaments.  Rhus has photophobia, and its thirst is not characteristic.

Mentally, Rhus has a lot of depression and anxiety worsening after midnight, and is prone to sarcastic remarks when in ill disposition.  It has a tendency to stupefaction with difficulty in finding the right words while speaking, or with indisposition to speak at all, while not finding a written expression to be particularly difficult, however possibly irritating.

Remedy chosen: Ruta graveolens in a classical split dose (Hahnemann) of 30C potency. I gave 5 pellets of 30C potency, to take one pellet in a glass of water per day, take one teaspoon of this solution, discard the rest, and repeat the process with the remaining 4 pellets over the consecutive 4 days. The patient took the remedy on July 15th, 16th, 17th, 18th and 19th, 2010.

Follow – up visit: August 6th, 2010

Patient reports:

My ganglion cyst is now the size of a pea and visible only if I make a tight fist. I was taking your remedy religiously and had the impression that the cyst was shrinking daily; at the end of the first week, it was the size of a hazelnut. It is hard for me to tell exactly for how many days it has stayed in the current size; I would estimate it for a week.  I believe it has not changed since the last week. I think that my scars under the jaw have softened and diminished as well.  Could it be true? Also, I think I do not have to yell as much when I talk, as if my hearing would have slightly improved but it could be my imagination. I noticed as if some change in the first two weeks, then it stayed the same. I had a very hard month at work as I received a promotion and had to assume many new responsibilities; had to fire someone, give an appointed interview to which I was supposed to prepare, then hire a new person and write some dreadful report. So many stresses as you see, and I did not have a single blood surge attack during that time.  Quite extraordinary for me. Just those liver spots are still unchanged.

My assessment: The remedy has worked deeply and gently producing immediate results with no aggravation. There is an improvement in several areas of concern (ganglion cyst, scars, apoplectic tendency, hearing loss, flexors, handling stress, possibly writing). I   repeat the 30C dose of Ruta in same mode of administration as before (classical split dose, 5 pellets for 5 consecutive days).   The patient took the remedy on August 6th, 7th, 8th, 9th, and 10th of 2010.

Follow – up visit: September 30th, 2010

Patient reports:

My ganglion cyst disappeared two weeks after I took the first dose of remedy last time.  In addition, my face scars are almost gone, or at least they are flat, soft, and much less visible.  Some of my liver spots are getting paler.  I have been outdoors in sunlight a lot though, so at least they did not get worse.  Also, my coworkers noticed that I do not yell as much on the phone.  I agree.  I think my left ear where I always keep the phone receiver at must have improved a little. We had several birthdays at school in the last month and I have to admit I was unable to avoid some sweets.  I had a few skin breakouts here and there in result, but they disappeared overnight and most importantly, I had no blood rushes to my head. I had one hard bowel movement a day, but not excessively difficult. I also have been feeling a little calmer inside.   In addition, I was somewhat less tired and sleepy during the day, and overall better in the evening.

My assessment: The classical split dose produced no aggravations and has advanced healing in several aspects of physical pathology, as evidenced by patient’s report and the physical exam. Since this time, this mode of administration seemed to weaken its effect somewhat later than before, albeit still after several weeks, I decide to give this time Ruta graveolens as a single dose in the 200C potency.  The patient took the remedy on Sept. 30, 2010.

Follow – up visit: December 1st, 2010

Patient reports:

The evening of the day I took the last remedy, I had a horrible attack of joint pain. It was as if all my joints would hurt at once, as if somebody would try to break them on a wheel.  It was a very violent pain.  I also found out that evening that I must need stronger reading glasses as I could not see too well in my old ones, and got a bad headache from the strain of my eyes.  So I went to bed, feeling useless and exhausted. The pain gradually diminished and I slept well through the night.  The next morning my pain was gone. I had a huge, soft bowel movement as soon as I got up, and felt relieved afterwards.  My joints were as if softer; I felt as if I could move with greater ease.  This was the only time since I took your remedy that I had some major difficulty. Those pains have never returned. I ended up not going to the optometrist as well because my old glasses have not caused me the problems anymore.

I did not have a single heat or blood surge to my head, which is amazing considering that I had two very demanding months at work.  I even most unexpectedly ran into the person whom I had to fire for major disciplinary trespasses. This person had been very upset about my decision and made many efforts to undermine my reputation.  The meeting went surprisingly well. I greeted her friendly and stopped by to exchange a few casual words; then person apologized for the past unfairness and we parted.  Aside from the fact that his behavior was as unexpected as the whole event, I was very surprised about my calm. I had no trouble with my usual heat surges or blood rushes, neither in that moment nor in weeks thereafter.  Some of my coworkers commented on my quieter manner as well. My hearing markedly improved, and I feel much less exhausted. I even do not think about my liver spots as much. I have been only rarely sad in the evenings. I recently had many reports to write, and for the first time, I did not ask my sister to help me as I used to do before.  I wrote them myself, with some minor technical assistance of my secretary.  I do not know if this is your remedy or my growing experience. After all, I am not young and have learned a lot in life. The changes are slow and subtle, and so it is hard to believe they could have been induced by something external.

My assessment: The single dose of Ruta in the 200C potency has exerted a further healing action in several aspects of physical pathology of this patient, as evidenced by patient’s report and the physical exam. It also appears to have had a deep, beneficial effect on patient’s mental-emotional state. There are no new symptoms. It appears that the remedy continues to work. I decided to take no action at this point.

Follow – up visit: March 1st, 2011

Patient reports:

Those last three months have been close to impeccable. I visited my family during the Christmas break, and then still took a trip for extended vacation.  I was able to avoid sweets with only minor exceptions. I had no problems with the bowels, skin, or blood rushes. I had only one head cold during those months – I caught in a drafty car as I was driving in a blizzard.  I ended up only with a cattarrh and some minor joint pain in my hands, but not with bronchitis, and I recovered in several days. Moreover, I did not feel particularily exhausted afterwards. I would say I feel about twice as strong and calm as I used to feel before. There still is a room for improvement of course but this already is a huge difference for me.  I still have some of my difficulties with temper and with writing, but I overcome them with a reasonable effort, and it somehow shows me that I have less to fear.  I do not consider leaving my job anymore, and it is easier for me to understand the shortcomings of my employees if any work problems appear.  It is easier for me to exercise; this winter I even started regular cross-country skiing every weekend. I have not injured myself even once, and it feels great to use legs and arms in a freer way.  I lost seven pounds and do not intend to stop there.  I have really nothing to complain about.

My assessment: Ruta graveolens has been bringing in this patient a slow, steady, and deep improvement in all areas of concern, beginning with the first time it had been administered. It clearly is the simillimum in this case. The patient’s physical issues are remarkably different compared to her first visit in July – there are no apoplectic surges, the hearing damage caused by them is largely reversed, there is greater flexibility in the joints, much better resistance to colds and upper respiratory infections, there is no constipation, no ganglion cyst and the hardened scars on her face are soft and barely visible. She feels physically stronger, exercises without injuries and started losing weight.  Psychologically, there is much less depression. She became calmer and started to overcome one of her greatest difficulties – expressing herself in writing, in situations carrying much professional responsibility for her. In this process, she also became more appreciative of herself and understanding of others.

Since there are no new symptoms and the remedy appears to continue to work, I decided to take no action at this point. I asked the patient to return for the next visit in two months or earlier should any problems occur.

End of case

About the author

Miroslawa Witalis

Miroslawa Witalis is a board certified Naturopathic Physician licensed in Washington State. She graduated from Bastyr University and has been practicing since 2007. She received a Diplomate from the Homeopathic Academy of Naturopathic Physicians and is certified by the Council for Homeopathic Certification. She also earned an MA in Medical Technology from the Medical Academy in Krakow and worked as an instructor in Pharmacology, Lab Chemistry, and Homeopathy at the Medical College in Krakow. For nearly 15 years she served as a consultant to health care practitioners in Europe on cognitive, sensory and motor rehabilitation of developmental impairments such as autism, OCD, dyslexia, and Down syndrome. She also served as director and instructor at the Institute for Consciousness of Time in Switzerland. Miroslawa was also an international consultant to organic and biodynamic farmers and several small homeopathic and biological medicine companies.


    • PS. The full case also contained detailed physical exam and the review of systems, which have not been included in the publication in sake of brevity. Repertorization included those where necessary.

  • Here it is:

    Repertorization using Murphy’s Repertory, 3rd edition:

    Mind; Depression, sadness; evening
    Mind; Discontented, feelings, dissatisfied; himself, with
    Mind; Discontented, feelings, dissatisfied; others, with
    Mind; Restlessness, mental
    Mind; Fears, phobias, general; animals, of
    Mind; Writing, general; difficulty, in expressing ideas when
    Mind; Light, mental effects of; desire, for
    Skin; Liver, spots
    Skin; Scars, cicatrices; hard
    Stool; Hard, stool
    Rectum; Prolapsed, rectum; stool, during
    Clinical; Colds, tendency to catch
    Clinical; Stroke, apoplexy
    Clinical; Stroke, apoplexy; ailments, from
    Joints; Contraction, of muscles and tendons, of
    Joints; Sprained, joints; tendency to
    Legs; Weak
    Wrists; Ganglion, wrist, on
    Vision; Weak
    Vision; Blurred, vision; evening
    Food; Thirst, general; extreme
    Food; Cold, drinks, water; desires
    Food; Sweets, general; desires
    Food; Sweets, general; ailments, from
    Generals; Exertion, physical; agg.
    Generals; Cold, temperature, weather; agg.
    Generals; Wet, general, agg.
    Generals; Lying, down, position, bed, in, agg.

  • i agree alan. the case is a v good learning example. thanks dr witalis for the repertorisation details.

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