Clinical Cases

Varicose Ulcer in A Man of 37

Varicose Veins LG

Dr. T. Himavani presents a case of varicose ulcer in a man of 37. Understanding that the fundamental miasm was psoro-syphilitic and the dominant miasm was syco-syphilitic helped guide the selection of remedies.

PRELIMINARY DATA:
NAME: Mr. M
AGE 37years
SEX: Male
Marital status Married
Occupation Shopkeeper
RELIGION Hindu
BLOOD GROUP: O +VE

Date of first visit : 20.06.2019

PRESENTING COMPLAINT:
Pain with swelling of lower extremities for the last 3 years

HISTORY OF PRESENTING COMPLAINTS:

• Patient was apparently normal 3 years ago. Symptoms developed gradually as pain and swelling in both lower extremities developed. Swelling increases with standing, Pitting, pain that started in right leg then left, pain of a burning in nature < standing, walking > rest, keeping legs elevated.
• Itching in calf region with discolouration of that part. Discolouration is yellowish to black, itching > warm application. Itching lead to ulceration; the discharge from ulcer is watery in nature.

TREATMENT HISTORY:
Took allopathic treatment previously, but symptoms recurred.

PAST HISTORY:
No history of T.B, B.A, chicken pox, HTN, D.M.

FAMILY HISTORY:
Father – not specific, Mother – not specific

PERSONAL HISTORY:
Born and brought up at Kurnool, India. Vaccinated. Vegetarian diet. He is working in a shop. No habit of tobacco or betel nut chewing.

PATIENT AS A PERSON:
Thermal state : Hot Pt
Appetite : Adequate
Thirst : Thirstless
Craving : Sour and spicy food
Aversion : sweets
Stool : Regular and satisfied
Urine : Regular and satisfied. D/N – 4/0
Perspiration : Normal
Sleep : Adequate ,dreams – not specified.

MENTAL GENERALS :
He belongs to a middle-class family. He works as a shop keeper. He is married and has a daughter and made her marriage. He has anxiety about his disease and wants to get rid of this soon. Apprehension, restlessness.

GENERAL PHYSICAL EXAMINATION:
Appearance – Dark complexion.
Build & nourishment – obese. Wt-85 kg, ht-5 feet 9 inch (BMI- 26.3 kg/h (m2)
No – Clubbing, Cyanosis, Jaundice, Lymphadenopathy, Pallor .

Vital Signs:
Pulse rate : 69 beats/min. Respiratory rate: 17 cycles/min
Temperature : Afebrile Blood pressure: 130/70 mmHg

SYSTEMIC EXAMINATION:

O/E:
Examination of both legs:
• On inspection: Swelling present in right calf, brownish discoloration of skin, lipodermosclerosis, engorgement of veins in medial aspect of right leg, hardening of skin in distal aspect of right leg, no scars, no signs of arterial disease like loss of hair, thickening of nails, surgical scars, pressure point between toes.
• On palpation: no thrill noted at sapheno-femoral junction by coughing. dilations are felt in medial aspect of calf and below the knee joint (right). Oedema +
Trendelenburg’s test – dilatation below the tourniquet.
Perthe’s test- cramping pain in calves, superficial veins remain dilated.
• On percussion: thrill felt at medial aspect of calf.

G.I T system:
Bowel sounds heard. No organomegaly.

CNS: clinically normal
RS: Normal vesicular breath sounds heard all over lung field. No added sounds

CVS: S1 and S2 heard in all four cardiac areas. No murmurs.
Criteria for this case:
1. Ulcer painful, discharging watery discharge sometimes blood, burning pain.
2. Pigmentation of skin
3. Heavy sensation < standing, > rest
4. Itching
5.Swelling
6.Weight

Date Symptoms Reason for selecting e remedy Remedy
20/6/19 As per the case Painful Ulcer discharges blood Millifolium 200
30/6/19

Wt-84 kg

Pain-reduced, discharge reduced

Itching reduced

As the ulcer is obstinate,i k rubric-rodent ulcer.(Clarke) Condurango 30
9/7/19

Wt-83 kg

Ulcer pain reduced,   s skin getting shrunken.

Itching, swelling reduced

Pigmentation still persists

Kent’s scale of series in degrees

Diet advised according to his blood group to reduce his weight.

Condurango 200
20/7/19

Wt-83 kg

Ulcer pain reduced, itching slight, skin is white, falls – white flakes. swelling reduced  As remedy is acting, wait placebo
31/7/19

Wt-82 kg

Fever with chills

Itching

Fever with chills /rigor d advised to take 1M after 2 days. Pyrogen 200

Pyrogen 1m

14/8/19

Wt-80 kg

Fever reduced, itching persists Swelling reduced pain-burning g pigmentation Depending on symptoms (sycotic basis)

Advised to take 200 after a week

Condurango 30

Condurango 200

28/8/19

Wt-80 kg

Patient is stable now observation placebo
13/9/19

Wt-79 kg

Pain is burning in nature

Swelling present- Discharge watery

Syphilitic base depending on symptoms Flouric acid 30
27/9/19 Pain is better, swelling reduced Kent series in degree Flouric acid 200
4/10/19 Reduced

Wt-76 kg

Flouric acid 1m
19/10/19

 

All complaints came to stand still. Depending on his case as constitution Arsenic 30
5/11/19 Complaints reduced Kent series in degree Arsenic 200
16/11/19 Patient is improving observation Placebo

 

Progress of disease & management
As per Organon of Medicine, the condition is a chronic disease (compound miasm). We can give only specified remedies. As the destruction of the tissue is present, we have to limit our prescription (posology) to lower grades, as higher potencies can damage further. Walk regularly, lift legs beyond the level of heart (15 cm), avoid lifting things. No smoking, keep skin clean and dry. Advised to follow O+ve blood group diet.

Varicose Ulcer in A Man of 37 1
Figure showing repertorisation of the case

Miasmatic review:
Fundamental miasm: psoro-syphilitic (past history, family,)
Dominant miasm: syco-syphilitic disease present condition, as it is obstinate)

About the author

T. Himavani

T. Himavani

Dr. T. Himavani completed BHMS in Government Homoeopathic College, Kadapa (AP), India in 2014, and his MD (practice of medicine) in Vinayaka Mission Homoepathic College, Salem (TN), India under the guidance of Dr. S. Sabari Rajan (Professor and H.O.D practice of medicine) in 2018. Dr. Himavani is currently working as consultant physician in Dr. Rajaram Homeopathic Clinic, Kurnool(Ap),India. I thank my father-in-law (Dr. L. Lakshmi Narayana DHMS) for giving support and encouragement for this work. I extend my gratitude to my aunt Mmvs Padma Sree for continuous support and timely help.

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