On 29th September 2022 A 31 year old lady doctor consulted me for complaints of cough that started the previous day. It was accompanied by dryness of mouth with thirst, mild soreness in throat. Irritation in throat was first, then cough. Cough would begin in the chest at the bifurcation of the trachea into right and left bronchus. She had the feeling that mucus was stuck at bifurcation of trachea. Itchy throat.
30th September 2022 – Dry cough with minimal sputum, sneezing and cough beginning from the throat. There is a foul odor coming from the mouth and throat. Cough is causing pain at bronchus. Drinking hot water helps itching in throat. Cough comes suddenly while inspiring.
Cough is worse on laughing, Worse on talking, Worse on exertion. Throat feels sore and itchy. Cannot bear draft of air. Feeling of congestion in both ears. Expectoration is yellowish and there was also post nasal discharge. Sometimes with the sputum there is little tinge of blood.
Chest pain observed in left lower aspect of chest on and off. (father suffered T.B and mother haemarthrosis of left knee joint). She observed that expectoration is more frequent in early mornings. Voice was hoarse. Feels better by eating solid food.
Got fever (heat) since last 3 days followed by chilliness. Increased appetite with fever. Suspected H1N1. Took Nux Vomica 1M, one single dose on her own on 30th September 2022.
1st October 2022 – Lot of coughing in the morning along with coryza. Itching and soreness of throat less. Hoarseness increased. Feeling very drained. Mild fever, continuous running nose with watery coryza. Day by day feeling more and more exhausted.
Bad type of dryness of throat with increased thirst. Felt better by drinking water. Fever 100’F, frontal sinuses feeling tender with headache. Sputum thick yellow. Took head bath in order to visit the Temple, Head feels better by wrapping up including covering over face. Cough is worse on talking and while inspiring. Wheezing present. Dryness of throat marked so much so that she starts crying from the irritation. Cough with expectoration. The sputum is causing tickling inside. Sputum sometimes yellow, sometimes white and she needs to breathe from the mouth.
Took Hepar Sulph 200, 1 single dose on her own on 1st October 2022.
After Hepar Sulph cough improved but nose congestion started. Has to breathe from mouth.
7th October 2022– Hoarseness improving but cough still present but expectoration is easy.
9th October 2022 – Cough still present. Sputum thick and sometimes thin, yellowish. She complained that she has lost weight in lower extremities only as compared to upper body. Despite not exercising for last 2 weeks, noticed that her tight jean pants are becoming loose in lower limbs.
Feeling tired easily. This time weakness was more than ever. Recalled that even during COVID (Jan 2022) and chicken pox (May 2022) that she experienced in this year earlier, she was good. Conjunctiva was pale. Haemoglobin reduced for no obvious reason.
She has started consuming tomatoes and beetroot to counter it. Bouts of cough take long to settle down. Thermally hot patient. Feeling very exhausted. More expectoration while bending down. Foul taste in mouth in the morning. While coughing feels upper chest is vibrating.
Expectoration feels stuck and relieved if she can expectorate. Has to thump the chest retrosternally to relieve herself. Now cough is starting from throat and not from bifurcation of trachea. Complaints of cough worse lying-in supine position. Prefers sweets to salty things. Has dewormed herself but no improvement. Wants to be in open air with ears covered. Voice was hoarse and unable to speak louder than whispering.
On 11th October 2022 – Suddenly she called up to speak about problems in her personal life. She informed me that her parents secretly planned a meeting with a boy and his family (marriage proposal). She thought that the boy may be visiting her home. However suddenly she was asked to dress up.
In a hurry she wore jeans and T-shirt which proved to be an embarrassment because the boy’s family was so well dressed. The match maker did not even introduce her nicely to the family of the boy. She was asked to sit in one corner with the boy.
They began asking her questions: “What are your expectations?”, “Will you travel from my home to the hospital where you work at present? And she was not able to reply appropriately as it was completely an unplanned event. The boy also told her that he had gone through her Instagram pictures which reflect her state of mind.
The place of meeting of the two families was also in a shabby locality. Until 3 days there was no reaction from the boy’s family. Later upon asking her father she was informed that they were not interested. Now her father could not digest this and she has started isolating himself from her and her mother, sleeping separately in the same house. He was abusing alcohol and insulting her and her mother all the time. It was fully chaos at home.
She worries about her mother’s and father’s health. She felt greatly duped by her parents. Next day an aunt of hers came and told her to just get married to anybody, as it’s a part of everyone’s life. It’s a contract. At last, she told me that she felt much relieved after speaking out her problem.
Anamnesis of the case done on 12th October 2022: In this the first thing to be done is to address the respiratory problem that is not getting fixed. Identify the important characteristics not only in the form of symptoms but also in terms of direction of disease, magnitude of disease.
The problem started with tracheobronchitis as the beginning then gradually as time passed in between there was fever, some medicine taken. Now what are the things that I see very striking? If we make any mistake disease will affect her mind producing a psychological condition or much deeper pathology of respiratory issue.
At this stage we may not look into mental aspects of her condition. Prescription is not based on disease diagnosis. Anybody going through such a situation will have disturbance but it is the degree of disturbance that matters and if it aggravated the disease that is there.
The respiratory problem and disturbance of mind are concurrently running without impact on each other. The disturbance is not intense (judged by her manner of communication) and affecting day to day thinking, her decisions, her performance. Or, whether there are certain mental expressions coming out as evidence that really show that the situation is affecting her.
Events may be there with no strong effect, then there is nothing to consider at all. Don’t get confused between state of her mind, and the present condition. Two platforms are available: One is respiratory platform, the other is life situation platform.
In between lies the clinical diagnosis problem which may allow you to understand the management part. So, this is the square of todays problem. Hence, we get totality of only respiratory issues from day one till today.
When evolutionary totality is unavailable then go for totality based on location, sensation, modality, concomitant or you can have Boger’s approach by judging pattern of response that is onset sudden, gradually progressing, Cold first settling in chest, ascending, progressively increasing and ending into weakness, or from particular level things are going into general.
But mind is not affected as far as respiratory concomitants are concerned. Do not add any interpretation of events to make it either concomitant or a mental state. We must be very careful. We have to prescribe now. We have an unresolving cough with characteristic modalities. Rubrics Considered: 1) Cough worse laughing, 2) worse talking: Arg-n, Cupr, Dros, Phos, Spong, Stann
3) bad taste in mouth in the morning. Only Arg-Nit.
Allen’s KeyNotes mention in Arg-N that emaciation is most marked in lower extremities. This symptom was the anchor symptom of this case. If one looks into the core delusion of Argentum Nitricum, we realise that she feels despised and forsaken (abandoned), delusion that she is repudiated by his relatives. This is exactly the essence of our patient’s life situation.
1st Prescription of Arg-Nit 200, 1 single dose administered on 12th October 2022 evening.
Follow Up on 13th October 2022– Took orange juice and later hot water. No aggravation of any complaints. Rather appetite has improved, not much cough, however slight irritation of throat present. Cough is now from throat and not from chest or bifurcation of trachea. Felt less exhausted. Came home after hospital duty and then cleaned her room, and still no drained feeling. Running nose stopped.
Follow Up on 16th October 2022– Occasional cough so her need of hot water reduced considerably. Dreams that she was video gaming in which she was escaping something.
Follow up on 17th October 2022– Cough returned but now its from the larynx. Started after consuming some juice at neighbour’s home. Intermittent cough. Worse on talking and laughing. Felt uneasy feeling in right side back as if she had some prolapse of intervertebral disc (Old symptom returning). Used to get this symptom on and off in the past. Felt better by pressure. No medicine given.
Follow up on 18th October 2022– No dry chest cough as was the case before. Cough only from throat. Stools had not been proper for long time (6 months) in the sense that not well formed and crumbled with difficulty in evacuation, needs to assist with finger. Thirst normalised and reduced as compared to last week during sickness. Tried cold things which do provoke cough.
Follow up on 19th October 2022– Overall better. Once dry cough starts gets continuous bouts which don’t settle easily. Then coughs intermittently. Exhaustion has reduced by 80%. She was asked about the thinning of her legs. She said that now it has stabilised since the patient found that the pants which were loose a few days back are no longer so loose.
She was asked to monitor her haemoglobin and report. She complained of appearance of tinea like dry eruptions on right dorsum of hand which developed after exposure to sun. No medicine given.
Follow up on 23th October 2022– She complained that cough is same and feels that medicine is not taking her any further. Complained that her cough is like that of a T.B patient. Worse on little exertion, worse by talking for long or even if she laughs little.
Gets 4-5 bouts at least in each cough. At this point I considered prescribing a dose of Tuberculinum 200, 1 single dose on 23rd October 2022. Reasons for prescription – Refer Boger’s Synoptic Key: ever changing symptoms not responding to the best of prescriptions.
The prescriptions are not getting registered deeply due to the underlying miasm (Tubercular taint). Her mind is also changeable and undecided. She is interested in fashion designing but not clear of how to go about it. Obscurity of a clear-cut diagnosis also favours Tuberculinum.
Tuberculinum is worse by motion (talking, laughing), worse by exertion, better in open air. This patient had pattern of lowered vitality. H.C Allens keynotes we find “Takes cold easily without knowing how and where”.
Follow up on 24th October 2022 – She got stinky loose motions. Watery, 4 times since early morning. (Tuberculinum has 5am aggravation). Felt drained. Same night felt mild cramps in transverse colon. Has to pass stool if eats anything. Advised probiotic and oral rehydration solution.
25th October 2022– Cough became more bugging as before and diarrhoea better. Cough without any expectoration mostly in the morning. Felt poking pain and unable to pass flatus.
26th October 2022– Felt some itching in medial aspect of left thigh and groin. Started since yesterday. Recollected that she had tinea there in the past which was suppressed by lot of allopathic lotions. She felt the fear that it might recur.
29th October 2022– Cough is 90% better. But in the morning, she saw a small eruption with mild itching. Was reassured that response is positive and that skin will not flare up like in the past. Explained that this is as a result of medication and not relapse of the disease.
3rd November 2022– She had a bad dream, in which some young male person is chasing her to kill her, the reason being that she is a non-Muslim and she tries a lot to dodge him, but in the end, gives up. There is another unknown girl with her and they were in some city with complicated buildings and complicated corridors.
He chases them with intention to kill. They both run and hide behind window and through toilet hole of old-fashioned toilet, then the girl asks her to bathe in some lubricant oil but the girl gets shot and dies. She tries all tricks even by taking someone’s car but still she gets caught.
He had some weird gun like blazing fire and heat coming out. Like the ones used for welding. Then she chooses to go close to him and act as if she will wrap her arms around him and he fires. Before she could feel the pain, she woke up. She said that in the whole dream she was thrilled about the escape part and not scared in the least. She wanted to win; it was like a game.
Follow up on 7th November 2022– Feeling alright. Cough occasional only on excessive laughing. Tummy feels bloated once again. Stool slender and crumbles, needs to use finger to widen the anal opening. Drinking less water.
Follow up on 10th November 2022– No emaciation of lower limb, No cough, No skin trouble, No weakness. She had a healthy discussion with her parents regarding pursuing fashion designing, she saw a dream that her sister-in-law delivered a baby girl.
Complaint of losing temper soon. This happens usually one or two days before menses. But it has been 4-5 days. Gets highly irritated. At home she tries her best but at last she blasts as she cannot control. At work, tries to keep quiet or not to give opinion since she speaks very sharply.
She even taunted her boss that now “don’t speak sarcasm”. At the moment, she cannot bear the slightest contradiction, it angers her. Hence tries to keep away. She also understands that her bad behaviour is spoiling other people’s mood since they get offended too, just like her.
Irritated for example, if she is not told all the details or if somebody forgets what she had said earlier. Today she skipped her lunch on account of her stubbornness. Her boss had promised to offer lunch but at last minute he forgot. Complaint of gaseous distension. Not able to pass flatus easily, worse morning and evening. Stool slender, crumbles, scanty and has to use her finger to widen her anus.
It’s been one year that she has passed a good formed stool. Desires sour tangy foods. Uses lime over salads. When upset or sad, cannot even weep freely. At that time consolation aggravates and she wants to be by herself. Cannot bear draft of air from Air conditioner it results in headache. Desires hot food but prefers cold drinks. Face is dry, lot of dandruff.
1)Angry before menses 2) Stubborn 3) Sadness worse consolation 4) Cannot have opposition Cham, Caust, Kali-c, Lyco.
Prescription given on 11th November; Lycopodium 200, 1 single dose (GIT affection, cannot bear hunger, fear of confrontation), although it doesn’t cover the character of stool. It seems to be her constitutional.
Follow Up on 4th December 2022: L.M.P 12th November 2022. Feels overall okay. No respiratory problems, no upper G.I issues. But the end of November started with bad hair fall (old symptom). Scalp dry and dandruff present. No constipation if consumes vegetables, sometimes has to strain at stools but better in the last 5 days. No complaints as such. No medicine given.
Follow Up on 6th December 2022: Got her menses on 4th December 2022 this time pain was not bad at all, rather bearable. No troublesome PMS this time. On second day of menses watery coryza began with slight sore throat. Frontal and maxillary sinus slightly tender. Doesn’t want to get exposed to draft of air nor wants fan. Desires to cover her face and ears. No medicine required as by next day coryza reduced on its own. No Cough.
Lessons: Acute remedies may relieve the fever or cold symptoms temporarily, but unless the PQRS symptoms and the mental concomitants of the case match with the remedy indicated from the homoeopathic materia medica, an actual recovery doesn’t occur. Here the susceptibility of the patient was good providing clear cut indications of different remedies.