A 4 year-old boy comes to my office with his mother. Since he was 6 months old he has suffered from recurrent respiratory infections, mostly bronchitis. He has bronchitis with fever every 2 months. They do not know how high the fever is because they always give antipyretics. However, it is at least 38°C. Each bronchitis is difficult to treat and it usually lasts for 2 weeks. He takes Aerius (antihistaminics) and Sinecod (antitusicum) in the acute stages.
During spells of cough he often vomits (3) and he sometimes suffocates (2) and is cyanotic(1). The mother says that opening a window helps him to breathe. In the past they also used Spiropent (Beta 2 agonist bronchodilator). The cough is usually worse in the morning after waking (1).
He is rather warm-blooded and uncovers himself at night (2). He likes to eat sweets (1), vegetables (2) and cucumbers (3). He can eat the whole cucumber at once. He has had this desire since he started eating solid food. He has an aversion to onions (1), fat (1) and meat (1).
He cannot bear his hair being cut or combed.(3) His mother uses electric hair clipper and he complains that it tugs him. He also refuses to wear glasses or anything else on his head.(3)
Lately he has developed obstinate behaviour (3) and he tends to be angry (2). If he wants something, he gets upset, stamps feet and screams.(3) He often contradicts when his parents want him to do something.(3) When he wants something and he does not get it, he strikes people.(3) I also observed this in my office. He punched his mother several times during the consultation because he soon got bored and wanted to go home. He is often dissatisfied and gets bored very quickly.(2)However, he is not malicious. This behaviour started about half a year ago.
His right eye is short-sighted (½ diopter).
His sleep is restless andhe moves a lot in sleep.(3) He usually sleeps on back (1) or on the right side (1).
9 months ago, he had a period of night enuresis. One year ago, he had a period where his perspiration had sour odour.
His father strong allergy to pollen with obstruction of breathing and has to take antihistaminics every day.
Note: numbers behind the symptoms mean their intensity (underlining). If the number is behind a symptom, it is valid for the particular symptom. If it is behind the whole sentence, it is valid for all symptoms in the sentence.
Analysis of the case:
This is typical of a child with a combination of recurrent acute infections and behavioural problems which we see in our practice very often these days (at least in the western world). The fact that the child has so frequent acute diseases means that his immune system is quite compromised. From the homeopathic point of view, this case is complicated by the fact that this child also has some symptoms on the emotional level. It means that the defence mechanism is too weak to keep the pathology on the physical level only (we consider the mental level and emotional level deeper than the physical). This makes the prognosis somewhat worse and it can mean that the treatment will take more time and more remedies will be needed. The other negative factors for the prognosis are the fact that he has had these recurrent infections since the very early age and genetic dispositions from his father.
From the pathological point of view, the physical disturbance is focused on the respiratory system. Particularly bronchial tubes are affected, which is a relatively deep organ system close to lungs. If such condition is untreated or suppressed by inconvenient treatment, it could lead to lung affections like pneumonia or asthma. There is also another possibility after a suppression – the child’s psychological condition might get worse.
Homeopathy can be very effective in recurrent respiratory infections and immune deficiencies in general, as well as in behavioural problems in children. Regarding the fact the boy’s level of health is relatively high, the prognosis is quite good.
Selection of symptoms:
From all the available symptoms of the case I chose these to be the most characteristic:
- desire for cucumbers (3)
- desire for vegetables (2)
- sensitive scalp, aversion to have hair cut or combed, cannot wear glasses (3)
- obstinate (3)
- anger with striking (2)
- disposition to contradict (2)
- dissatisfaction (2)
- restless sleep (3)
- myopia of the right eye (2)
Relevant rubrics from the repertory: (using The Essential Synthesis repertory)
GENERALS – FOOD and DRINKS – cucumbers – desire
GENERALS – FOOD and DRINKS – vegetables – desire
HEAD – SENSITIVENESS – Scalp, of
HEAD – SENSITIVENESS – brushing of hair; to
HEAD – TOUCH – agg. – External head
MIND – OBSTINATE (- children)
MIND – ANGER (- children; in)
MIND – STRIKING
MIND – CONTRADICTION – disposition to contradict
MIND – DISCONTENTED
SLEEP – RESTLESS
VISION – MYOPIA
GENERALS – HISTORY; personal – bronchitis; of recurrent
Differential diagnosis of the most probable remedies:
Belladonna can be very irritable and even violent, with striking or biting, pulling other’s hair, etc. It has complaints from having hair cut but mainly because the remedy is sensitive to cold draft and shortening of the hair makes the head more susceptible to it. Belladonna is worse from touch in general. It can have restless sleep, although it is not a keynote. It has desire for vegetables. However, the remedy does not have any real keynote in the case.
Nux-vomica is an angry remedy and can hit in anger. Is it very sensitive to external impressions, including touch. It can have restless sleep, but it cannot be confirmed otherwise.
Chamomilla is one of the main remedies for children with behavioural problems. It covers anger with aggressive elements like striking, kicking or throwing things. It belongs to the main remedies for dissatisfied and obstinate children. It has a strong aversion to be touched in general, but not particularly on the head. We can even find sour perspiration in this remedy in the Materia medica, but as this is an older symptom which is not present at the moment, I am not taking it into consideration. Chamomilla has restless sleep. Irritability and anger are essence of this remedy.
Cinamaritimais very similar to Chamomilla in many respects. It covers the obstinacy, anger with striking and aversion to be touched as keynotes. It also has a strong sensitiveness of the scalp. Children who need Cina cannot have their hair combed or cut.6 It belongs to the main remedies for behavioural problems in children, it is very dissatisfied and covers restless sleep. Like Chamomilla, this remedy also has sour smell of the body, although not as a keynote.
Tuberculinum is a remedy we should think of when we see a combination of irritability and respiratory complaints (especially in recurrent respiratory infections). It is one of the most important remedies for irritable children where the anger has an aggressive form and destructiveness. This child is not destructive, he does not break or throw things in anger. Tuberculinum covers striking during anger. It has a strong aversion to be touched in general and we can find a confirmation for sensitivity of scalp in Phatak’s Materia Medica. Tuberculinum is never satisfied. It has restless sleep.
AntimoniumCrudum covers a peculiar keynote in the case – desire for cucumbers. It is the only remedy that has this symptom as a keynote in the Materia medica.3It belongs to the main remedies for behavioural problems in children. Children who need this remedy can behave somewhat similar to Chamomilla. They are irritable, dissatisfied, peevish, and have strong aversion to be looked at and touched. However, children who need Antimonium crudum are not aggressive and do not attack or strike.
From the above discussed remedies Chamomilla, Cina, and Tuberculinum seem to be the most similar to this case. All three remedies are dissatisfied, angry and all are able to strike when irritated. They all can be capricious. The difference is, that in Chamomilla children the primary characteristic is malice. They are over-reactive and their expressions of anger are malicious. Cina is rather capricious, they can strike or be aggressive, but it all comes from the capricious element of not feeling comfortable in almost any situation. Tuberculinum’s main themes are boredom and destructivity. They cannot endure being bored and in their anger, there is always some kind of destructivity.
The symptom which is decisive in this case is the sensitivity of head to touch or any kind of other discomfort (glasses, etc…). This symptom can be confirmed best in Cina, for example in G. Vithoulkas’ Materia Medica Viva. During my observation of the child’s anger, I could not see any malicious element. The contradiction and striking seemed to come rather from inner boredom of the child so this makes Chamomilla and Tuberculinum less probable. If we look in the rubric Mind-contradiction-disposition to contradict-children, in, we can find only one remedy there – Cina.1This remedy interesting is that it can be found in the rubric Chest-inflammation-Bronchial tubes-children,in in the second degree.
With regard to what is written above, I preferred Cinamaritima as the first prescription. I chose potency 200C because of the child’s probably relatively high level of health. I say probably because we are not sure about how high the fevers of the child are.7 Another reason why I would not use high initial potency at the moment is that there are possibilities of other remedies, in other words, the picture of the remedy is not perfectly clear.
Prescription: Cinamaritima200C single dose
Outcome of the treatment:
Follow up #1 – one month after the remedy
After administration of the remedy, there was an aggravation on the emotional level for a few days. On the second day the boy was very weepy. On the third day his anger got more intense, he was more aggressive, disobedient and more obstinate than usually. On the fourth day he started gradually improving.
His emotional problems have improved by 50%. He is much calmer and obedient now. The mother reports that before treatment he had often laid himself to the ground and had had spells of anger which now disappeared (she forgot to tell me about this at the initial consultation). He does not strike people any more. He is also less restless and is able to focus better on things. For example, the parents took him to the circus and he was able to pay attention during the whole performance and he can remember details from it. This was not possible before the treatment.
They visited an opthalmologist and he pronounced an improvement in his eyesight.
Four weeks after taking the remedy (one week ago) he got a bronchitis. However, this episode was milder than the previous ones. This time the boy did not vomit at all and did not suffocate. He was expectorating profusely and the whole disease lasted for about six days. He had no fever and no malaise. His mother used Aerius syrup for two nights and Spiropent once (without consulting me).
The mother reports, that he is more thirsty now (2) and he drinks more water whereas before he demanded sweet drinks all the time. He has a better appetite (1). He desires more meat (2) and has less desire for sweets.
Evaluation of the follow up #1
The there was an aggravation on the emotional level followed by significant general improvement. This means, that the remedy was correct and it is necessary to WAIT. The fact that the acute episode was milder and less complicated compared to the previous ones confirms that we have improved the boy’s general condition and we have raised his level of health.
Follow up #2 – 2 months after the remedy
Since the last follow-up the emotional problems of the boy have improved even more. The mother reports that his behaviour is now without any problems and he behaves like an average child. My observation confirms that the boy is calmer, he is not angry at all and keeps sitting down without complaining during the whole consultation. He has no problems with cutting his hair anymore but he still does not like to wear glasses. He communicates with me, whereas before treatment he did not want to answer my questions.
Two weeks after the last consultation the boy got another cough which lasted for ten days. There was also a coryza. The mother did not use any chemical treatment. He did not have high fever. The cough was milder than the previous episode and it did not affect bronchi. He did not vomit and his breathing was not affected. However, for the last few days he coughs a bit now and then, but it not an acute state.
Evaluation of the Follow up #2
The appearance of another cough episode after a relatively short time might appear to the reader as a decline in the general condition of the patient. But we have to keep in mind that the boy’s psychological level has improved significantly and both episodes of cough were less serious than before the treatment. Neither of them affected bronchial tubes and breathing and they both lasted shorter than before treatment in spite of the fact the mother did not use chemical drugs (only very little during the first episode and not at all during the second one).
In patients who have both psychological and physical complaints, the organism has a tendency to improve the psychological level first and the improvement in the physical level may come later. Of course, it also depends on the seriousness of the pathology – not all physical complaints are less serious than the psychological problems.
The organism sometimes even shifts the pathology from the psychological level to the physical and the physical level may even get temporarily worse. In this case, we already have some improvement on the physical level too so it is necessary to WAIT.
Follow up #3 – 4 months after the remedy
There has been no acute episode of cough, however, since the last consultation, the mild chronic cough has persisted and in the last few days, it got more intense. The cough comes in paroxysms.(2) The biggest spell of cough comes every morning after getting up and then the other spells gradually decline in their intensity.(3)The very first spell is the most intense.(3) During the rest of the day he coughs only a little. He sometimes vomits during the morning spells of cough (2). He never vomits in the afternoon or evening. Before vomiting, he complains about pain in the stomach (2).
His emotional state was good until the last 2-3 weeks, when he started getting worse again. However, the symptoms are different from the state before the treatment. Now he often moans and complains (3) and he is dissatisfied (2) and capricious (2). He does not contradict or hit anybody and is not angry. He has become restless again and has had problems with concentration.(2) The sensitivity of scalp has not come back.
He still desires cucumbers (3) and still can eat the whole cucumber at once. He still has aversion to onions (2). His thirst has come back to normal (after Cina it got more intense). He drinks about 1,5 litres a day. He prefers lukewarm drinks.(1) They are not aware of anything that could have negatively affected the boy. There were no antidotes.
Evaluation of the Follow up #3
There is a partial relapse in the case. The general state of the child has declined both psychologically and physically, but not to the same degree as before the treatment. There were no antidotal factors which means the relapse is spontaneous. Most probably the remedy has exhausted its action. Because the general state keeps worsening and especially because of aggravation of the cough, the case needs some intervention.
It is important to notice that the symptoms have changed and there are some new peculiar symptoms to consider. What we need to do now is to evaluate the current symptom picture and see whether the same remedy is still indicated or another one is needed.
Selection of symptoms:
- desire for cucumbers (3)
- cough worst during the first spell in the morning after rising (3)
- cough with gastrointestinal symptoms (pain in stomach) (3)
- vomiting from cough (2)
- restlessness (2)
- difficult concentration (2)
- moaning and complaining (3)
- capricious (2)
Relevant rubrics: (using The Essential Synthesis repertory)
GENERALS – FOOD and DRINKS – cucumbers – desire
COUGH – PAROXYSMAL – morning – rising agg.; after
COUGH – MORNING – rising – after – agg.
STOMACH – COMPLAINTS of the stomach – accompanied by – cough
STOMACH – PAIN – cough – during – agg.
STOMACH – VOMITING – cough – during – agg.
MIND – RESTLESSNESS – children, in
MIND – RESTLESSNESS
MIND – CONCENTRATION – difficult
MIND – MOANING – children, in
MIND – CAPRICIOUSNESS
Differential diagnosis of the most probable remedies:
Cina maritime is the most important remedy when there is strong capriciousness in the case. We can consider it a psychological part of the essence of this remedy. It covers moaning, however, it is not so prominent in this remedy. It covers gagging and vomiting from coughing. Cina has several important cough symptoms. For example, it is an important remedy for violent type of coughs like whooping cough. It covers paroxysmal types of cough and has hacking cough in the morning after rising. Cina has strong restlessness. The fact that it has already acted favourably in the case gives another score point to this remedy.
Antiominumcrudum covers desire for cucumbers as a keynote. There is no other remedy for which this symptom is a keynote. On top of that, it has exactly the same type of cough as our patient. Apart from typical Antimonium crudum cough aggravated by looking into the fire or entering a warm room, this remedy has a peculiar type of paroxysmal cough worse in the morning after rising where the first attack of cough is the most severe and the others gradually diminish in their severity.4, What is also typical is for this remedy is that the cough is usually accompanied by some kind of gastric disturbances. Antimonium crudum has a strong affinity to stomach and digestive tract. The remedy also covers the current psychological picture of the case very well. It covers dissatisfaction with moaning and capriciousness. These patients can even be very irritable (esp. children) like Chamomilla but unlike Chamomilla, they are not aggressive.