In-house Consultant, the other song
With this case, I would like to share my experience being associated with ‘the other song’ academy, working with legendary Dr Rajan Sankaran and trying to incorporate his teachings into my practice. This case is an illustration of his teaching. Dr. Sankaran is often asked which approach to take during the case taking process and his answer would be, just to follow the patient. Begin the case from where the patient’s level is, and complete the symptoms in their totality, i.e. origin, duration, progress, location, sensation, modalities (aggravating and ameliorating factors) and concomitant (associated symptoms).
Often we get the clue of the remedy from this totality and the rest of the case needs to be viewed in the context of what solid information we have established so far. In other words, we need to look into the case for further indications of a remedy (which the totality gives a clue for) before we can affirm it as the similimum for the case.
This case, consulted by Dr. Pratik Desai at the other song clinic has been edited for brevity. The sentences in italics denote the doctor’s understanding.
To elaborate this concept I am presenting this case of a 27-year-old single man living in central India who urgently requested an appointment at ‘the other song’ academy for the treatment of arthritis of hip joints, which he was suffering from since 2011. I first saw him on 5th September, 2013. The patient complained of pain in hip joints either the right or left side. He said that at a time only one joint was affected. The pain started after he had met with an accident in September 2011. The patient had fallen from a bike and had some bruises on his left knee and left upper limb due to the resulting injury, but he had no fracture. His injuries were better in 2 weeks and the pain has ceased. Two months later, to his surprise, he felt pain in his hip joints. Over the past 6 months, the intensity and the frequency of the pain had markedly increased.
The pain was severe and every episode of pain lasted for 8-10 days. It was then difficult for him to manage his routine. He described the pain as very intense and unbearable, and aggravated mostly at night and in cold weather. Whenever the pain started, it became difficult for him to even turn to the side when in bed, or to pick up something from the floor. The patient said that the pain was so horrible that it used to take half an hour to just turn to the side. He described it as, “It is a big task or target for me to change the side”. He had to take support of something and only then he was slowly able to manage to sit or turn to the side.
So here we have information about the origin or the causation of the disease, its location, its intensity and some aggravating factors. Now we need to understand the type of pain or sensation and if there is any concomitant associated with the pain which will then complete the detailed description of the local complaint i.e. pain in hip joint as regards the location, sensation, modality and concomitant.
The patient described the pain as a kind of an electric shock, or jerk, as if someone had bitten him hard. Sometimes, he felt as if his leg was not there as he could not twist or turn and hence had to be in one position for a considerable time. The pain got worse when he stretched his leg, or bent it at the joint. The pain that he then felt was as if the bone had broken, or as if someone was pulling intensely at the bone. As a result, it became difficult for him even to stand from a sitting position, or when he tried to ride a bike or car. When in pain, he could not even talk to anyone and he was very irritated if someone tried to talk to him.
He further described the painful part as very stiff and hard and he had to make cycling motions clockwise and anti-clockwise so as to render the part soft. I asked him to describe the experience of being pulled and twisted and he said that it was as if someone was twisting the leg from the hip joint and it was so intense that he often felt that he should remove the entire leg. It was with great difficulty that he controlled and tried to bear this pain.
The patient then described the experience of being twisted as if somebody was giving too much pressure, as if squeezing the leg. He described the experience of squeezing (hand gesture) as if somebody was draining a wet cloth from by applying too much of pressure from both sides from opposite directions so that all the water was removed. He said that the pain felt so pressurizing that it felt as if it would break the bone or remove it from its attachment.
Now we have a complete description of the pain in hip joints as well as the words that the patient used to describe the pain sensation were pulled, stiff, beaten, broken, twisted and squeezing. Here we get the complete description of the experience of pain in hip joint and sensation words that patient has used were pull, stiff, beaten, broken, twisted and squeezing. So we need to find a remedy which has all these qualities of pain. Now we also need to examine other areas of his life and to see whether they match the remedy that we are looking for.
The patient described his nature as being aggressive, not being able to control his anger. He did not trust people easily. He is helpful to others and gets sentimental over small matters. He was emotionally hurt when his friend to whom he had extended full help and support, broke off his friendship due to some misunderstanding. He described the experience in that situation as of being used and said, “When his motive was over, he had used and thrown me out.” The feeling was that he had treated me as if I had done something wrong.
He described another situation with his elder cousin brother who had promised him that he could stay with him as long he wished, but when he got married, he asked the patient to leave his home. He felt that all responsibility of his family came over him and he was controlling all his aggression within him. He felt very bad that his cousin has told him something but acted otherwise. When time came to follow the commitment, he turned to the side.
The patient has fear of ghosts and of being killed by them. He said that ghosts kill you by tying a rope around the neck and pulling up so that the person is hanged. He has dream of snakes and he is scared of them. In food and drinks, he craves for non vegetarian food and fresh juices especially orange or sweet lime.
|Analysis of the case:|
|Here in his case what is prominent or peculiar? The peculiarity is the description of his pain in hip joint. We have the following information about the pain in hip joint,|
– It has started after injury
– Affection of hip joint
– Pain comes on alternating side; one leg is affected at a time.
– Pain agg at night, worse in cold weather, worse from stretching or turning the side.
– Sensation as if, electric shock, pulled, twisted, squeezed, hard pressure and broken.
– Effect of the pain is he tries to control it, as if it’s a big task for him to turn the side in bed.
– He gets irritated and frustrated with the pain.
This local totality gives a clue of the remedy. Here, we are looking for a remedy which has all these qualities, ailments from injury, affection of hip joint, with above mentioned modalities and sensation. And we have only one remedy which has all these characteristics together, which is Ruta graveolans.
Now, we have to see if the rest of the case matches Ruta g too. And if this is true then the rest of the case has to match with the Ruta g.
If we are to look at the other aspects of the case, we see that he felt used by his friends. The feeling was they had stopped talking to him as if he had done something wrong (delusion wrong he has done). In another incident with his cousin, we see when the cousin asked him to leave his home after his marriage; the patient felt that he could not trust anyone. The main feeling here was that people do not keep their promises; they say something and do something else. So here, we have the rubric Delusion, deceived being.
Another peculiar aspect of the case was the dream where the patient was afraid as he felt that the ghost tied a rope around the neck and then hanged someone. Considering all these symptoms, we have the following rubrics :
At the local level:
(Roger van Zandvoort, Complete Repertory, Mac Repertory, 8.2.01, Professional, Kent Homoeopathic Associates)
Rubrics of mind:
(Roger van Zandvoort, Complete Repertory, Mac Repertory, 8.2.01, Professional, Kent Homoeopathic Associates)
We see that the remedy Ruta, is the most prominent on Repertorisation. Also if we are to look at the case from the System understanding, i.e. through Sensation Approach, we get
- Kingdom- sensitivity and reactivity in the patient indicates that the patient needs a plant
- Vital sensation and reaction- pulling, stretching, twisting, squeezing, breaking. This is the sensation of the plant family Rutaceae.
- Plant family: Rutaceae
Rutaceae is also known as rue or the citrus family or family of lime and oranges. This family includes fruits of great economic importance such as sweet oranges (citrus sinensis), lemons (citrus limonum), Mexican lime (Citrus aurantifolia), sweet lime (Citrus limettioides Tan), grape fruit (citrus decumana), tangerines (citrus reticulate), Bengal quinces or Bael fruit(Aegle marmelos), Casimiroa or white sapote (Casimiroa edulis) and Wampee (clausena lansium), etc. and includes common remedies like Aegle (A. marmelos, A. folia), Angustura vera, Pilocarpus pinnatus/ P. jaborandi, Ptelea trifoliate, Ruta graveolens, Xanthoxylum americanum.
Ruta g is one drug from this family which is well proved and a well known remedy in our Materia Medica. It represents the central theme or sensation of Rutaceae.
In Ruta, we find many references related to sensation words such as; “Choking, constricting, strangling, squeezing, crushing, twisting, stretching, pressure, broken, sprain or injured”
To conclude, the vital sensations of Rutaceae are Squeeze, Compress, Constrict, Twist and then Break and Crush.
Sensation and reactions of Rutaceae family:
Squeezing and twisting
Squeeze and break/crush
Squeeze and compress
Constrict and squeeze
Twist, compress and break/crush
Choking/compressing/strangling and then crushed.1
Miasms are the coping mechanism of a person in response to how an external stimulus is being perceived. In other words it’s a pace and depth or degree how the vital sensation is being perceived. In the cancer miasm an individual perceives the external stimuli as chaotic and he wants total control or an order of his situation.
“There is chaos everywhere; control is almost impossible, but it is my responsibility to strive to bring about order.”
- They perceive life as if it is out of control, want perfection, too much of expectations, wants everything in order, for that they need to do a superhuman task, beyond one’s capacity or limitation.
- The same expressions we find in our patient when he said that to turn the side in bed is big task for him, to stand up from sitting is huge task, and also in situation with his cousin when he told him to leave the home he said I kept my anger in control, how to manage too many things, the situation was out of control and one needed to do supper human effort to bring in order. This was indicative of miasm in the case i.e. Cancer miasm.2
- Cancer: (miasm indicator in the case)
- huge task for me/ all responsibility came on me/ somebody is pulling and I am trying to control.
So at the cross point of vital sensation of the Rutaceae family and cancer miasm we find remedy Ruta g. This combination of the symptoms on one side and system on the other leading to the same remedy is a synergistic combination. This makes us all the more sure of the remedy needed for the patient
- Remedy – Ruta g (Rutaceae + cancer miasm)
- Potency: 200C, single dose, because his level of experience is emotions or level 3, he gets angry and irritated or frustrated with the pain. These were his spontaneous expressions while describing the pain.
One month later (5th Oct 2013)
“I am doing much better; in fact the pain was disappeared on 2nd day itself after taking the medicine. Since then there is no pain. Now I am able to do my work and have no pain. Day-by-day things are getting better and better. Laziness is also decreasing. I am able to do my work fast. I am getting good sleep, no problem in turning the side. Over all I feel 99% better. Earlier, pain used to come on after driving or after exertion; that is not the case anymore. Now I am more confident, not worried if I have to go somewhere or have any meeting why some senior people I feel confident.”
Plan: placebo was given.
24th December 2013 (three months later)
“I am feeling day by day, now there is no problem while travelling, I feel that I can run and even chase the bus. There is no pain, so that now I feel that I am totally fit. There is no feeling of pain, I am feeling all positive and feels that everything is going good. Now there is no problem in driving and sleeping, I am getting good sleep. This time, there is no pain even when the winter was as its peak. Health-wise I am more positive in my mind and body. I am looking for another opportunity for my career. Now I feel that I can achieve my targets now there is no doubt in mind. I am more positive towards myself and about my work.”
1 year later
“I am much better. I have not experienced pain since first dose itself. Now the life has changed entirely. Earlier because of pain, my entire confidence was lost, but now I take part in many things and activities. Recently I had participated in a play in our annual company event. I even danced there, met all people. I can do all work assigned to me, can travel anywhere, anytime. There is no sleeplessness, no fear. My confidence is at its best. I can solve any problem.
Earlier I was very aggressive in my approach, I used to come to conclusion without understanding it, but now I take time to think and understand the issue and then I give my opinion so my reactions are well in control. I also listen to people, I listen to their perspective. Now I don’t feel any fear or tension in my mind.”
At this point I felt he does not require any further medication as there is no relapse and his state of mind proving well so I advice him to visit as and when require. And till date he is doing fine and there is no recurrence of his complaint of pain in hip joint.
Lessons from this case
What is learned from the case was that we need to go into finer and exact detailing of symptoms. Here, the patient presented with pain in hip joint, alternating sides, with electric-shock or current-like pain one can think of Ranunculaceae or with description of pain as if bruised and broken one can think of Arnica, with the words stretching and twisting or bending/ turning one can think of the remedy Dioscorea or stiff and need for movement one can think of Rhus tox, but when we see all the expression of the patient put together with the symptoms, we get an exact picture of Ruta, where we have affection of bone and hip joint, ailments from accident, bruised-broken, electric shock like pain, twisting, stretching and squeezing type of pain. The similimum thus selected acts wonders.
1: Rajan Sankaran, Rutaceae, Insight into Plants – Vol 3, Homoeopathic Medical Publishers.
2: Rajan Sankaran, Miasms, Sensation in Homoeopathy, Reprint 2009, Homoeopathic Medical Publishers.