NAME: Mr. M
Marital status Married
BLOOD GROUP: O +VE
Date of first visit : 20.06.2019
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.
Took allopathic treatment previously, but symptoms recurred.
No history of T.B, B.A, chicken pox, HTN, D.M.
Father – not specific, Mother – not specific
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 .
Pulse rate : 69 beats/min. Respiratory rate: 17 cycles/min
Temperature : Afebrile Blood pressure: 130/70 mmHg
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
|Date||Symptoms||Reason for selecting e remedy||Remedy|
|20/6/19||As per the case||Painful Ulcer discharges blood||Millifolium 200|
|Pain-reduced, discharge reduced|
|As the ulcer is obstinate,i k rubric-rodent ulcer.(Clarke)||Condurango 30|
|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.
|Ulcer pain reduced, itching slight, skin is white, falls – white flakes. swelling reduced||As remedy is acting, wait||placebo|
|Fever with chills|
|Fever with chills /rigor d advised to take 1M after 2 days.||Pyrogen 200|
|Fever reduced, itching persists Swelling reduced pain-burning g pigmentation||Depending on symptoms (sycotic basis)|
Advised to take 200 after a week
|Patient is stable now||observation||placebo|
|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|
|Flouric acid 1m|
|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.
Figure showing repertorisation of the case
Fundamental miasm: psoro-syphilitic (past history, family,)
Dominant miasm: syco-syphilitic disease present condition, as it is obstinate)