A Clinical Experience: A Case of Depression
Mrs M, 80 years old, DGHD Aali village OPD (regn no 2334), was first brought by her daughter-in-law on 19-May-15 for constant weeping/ moaning and restlessness due to stomach pain, headache and sensation of heat in body for the last few months. She was short statured with a scrawny physique. Her complaints had worsened over the last month. Abdominal ultrasonography done on 6-5-15 revealed ‘dilated right sided bowel loops and right sided lower pole renal cortical cyst’. Antidepressants and analgesics taken over last few weeks had provided little relief.
Considering her scrawny physique along with restlessness and sensation of heat, she was prescribed Secale corr 30 tid for 3 days followed by placebo the same day.
Her daughter-in-law brought her for a review, a week later on 26-May-15. The pain in abdomen and headache persisted, however, she could sleep better and weeping had reduced. Sensation of heat, however, persisted. She was continued on placebo.
The lady visited the dispensary by herself on 2-June-15 saying that her pains and heat had reduced. Her cheerful demeanour precluded any further repetition of the remedy. She continued to improve on placebo over the next few months of follow up.
THE SOURCE OF THE REMEDY SECALE CORR
|CLAVICCEPS PURPUREA||ERGOT ON RYE|
|Ergot infected and healthy grain |
The name Ergot is applied to a group of similar tiny ascomycetes fungi that occur on grasses (including some cereal crops). “Ergot” is the French word for “spur”. Long ago, people in France noted some resemblance between the sclerotia and the spurs on rooster legs. Claviceps purpurea is an ergot fungus that grows on the ears of rye and related cereal and forage plants.
Origin of the generic name Claviceps is the Latin noun clava meaning a club, –ceps meaning head-hence club-head fungus. Purpurea is a reference to the dark purple colour of the sclerotia.
|· Its appearance has been linked to extremely cold winters followed by rainy springs. Sclerotia germinate in spring after a period of low temperature|
· A temperature of 0-5 °C for at least 25 days is required. Water before the cold period is also necessary.
· Strict organ specificity (ovaries)
· The plant lacks defense reactions
· Biotrophic life style
|Fruiting bodies with head and stipe on sclerotium |
There are very early references to ergot in history: for example, a description on an Assyrian tablet in 600 BC referred to it as a ‘noxious pustule in the ear of grain’. Around 350 BC, in one of the sacred books of the Parsees, descriptions were found of ‘noxious grasses that cause pregnant women to drop the womb and die in childbed’.
|Painting by Matthias Grünewald in approximately 1512–16 of a patient being struck down by St. Anthony’s Fire. (1512–1516 © musée d’Unterlinden, Colmar)||A close up of figure on left lower corner of the paiting, depicting ergotism, with hallucinations, burning limbs and gangrene.|
|St. Anthony’s fire (also known historically as Ignis Sacer and Holy Fire) may refer to one of the following diseases:|
Ergotism (this meaning is particularly common in France and Germany)
Erysipelas (this meaning is particularly common in Britain and the United States)
Herpes zoster (this meaning is particularly common in Italy and Malta)
The common name is St. Anthony’s Fire, in reference to monks who specialized in treating ergotism victims with balms containing tranquilizing and circulation-stimulating plant extracts; they were also skilled in amputation.
|St. Anthony. From a woodcut made in Germany about 1440-50 A.D. (TOP)|
The epidemics of ergotism have been reported since antiquity.
|·Usually the gastrointestinal effects precede central nervous system effects.|
|·Convulsive symptoms include painful seizures and spasms, diarrhea,|
paresthesia, itching, mental effects including mania or psychosis, hallucinations and other distorted perceptions, nausea and vomiting.
|· Ergotamine-ergocristine alkaloids cause vasoconstriction of blood vessels, mostly of the poorly vascularised distal structures like fingers and toes.|
· It causes a feeling of burning skin or insects crawling under the skin, desquamation or peeling, weak peripheral pulses, loss of peripheral sensation, edema and dry gangrene ultimately the death and loss of affected tissues and loss of limbs.
· When it takes on the gangrenous turn, the first symptoms to appear are a heavy aching pain in the limbs, an intense feeling of coldness, and a general weariness and languor. Then a dark spot appears on one of the extremities. On the dark livid spot, mortification sets in. It may be either dry or moist, but mostly dry. It is of the same nature as the senile gangrene or what is induced by a frost bite.
The most recent epidemics have been in 1951 at Pont St. Espirit, France, with hundreds of residents violently hallucinating and (the most recent) in mid-2001 in Ethiopia! [9,10]
More recently, Robin Cook based his 1994 novel, Acceptable Risk, on an ergot-like fungus isolated in Salem, Massachusetts!
THE IMPORTANCE OF DOCTRINE OF SIGNATURES
As I have learned from my teachers, those features, which are a characteristic nature of the remedial source and also found in their homoeopathic drug proving, are of extreme importance. Some of these (derived from the above-mentioned points) are as under:
- A remedy with strong affinity for gangrene like states (its physical appearance and name ‘purpurea’)
- A woman’s remedy (the fungus has an affinity for ovaries)
- Its ability to withstand extreme cold (so can the sclerotia)
- Its application in immuno-suppressed/ immune-compromised conditions (the plant lacks defense reactions)
SOME IMPORTANT CHARACTERISTICS
- This drug is especially adapted to thin, scrawny women.
- Old, decrepit persons.
- The face is pale, pinched, ashy, and sunken and hippocratic.
- Skin is dry, harsh, shriveled, sallow complexion.
- The eyes are sunken too with blue rings around them. The vision is dim, and the voice is husky and creaky.
A hemorrhagic remedy
- Secale is one of our great hemorrhagic remedies. This hemorrhage may take place from any outlet, but is generally from the uterus.
- The patient is feeble and cachetic, exhausted by a prolonged stay in tropical climates.
- The flow is black, fluid, non-coagulable and offensive.
- It is aggravated by the slightest motion.
- Before losing consciousness, tingling sensation all over the body, wants to be rubbed.
- ..but the one characteristic symptom to guide us in all these troubles is the steady flow of dark, thin blood, which prostrates the patient beyond measure.
- The pulse becomes thready, and the appearance turns haggard and woebegone.
- There is tingling and formication in the limbs.
- The great desire for fresh air, aversion to being covered and burning are all important symptoms to be considered.
- Compare: For general hemorrhagic tendency- Ustilago, Bovista, Mitchella repens, Trillium pend, Hamamelis, Erigeron; For uterine hemorrhages- Aletris farinosa, China, Helonias.
- Prolonged, ineffectual uterine pains.
- Loose, open, lax, but labor does not seem to advance.
- After pains
- Post partum hemorrhages, hour glass contractions
- Foul, offensive lochia
- Laughs, claps hand over head, besides herself; lies naked, immodesty, puts fingers inside vagina and scratches.
Tendency for abortions
- Secale is one of the few remedies that we prescribe for patients who suffer from habitual abortions.
- The miscarriage in this remedy generally takes place about the third month with copious flow of black, bad smelling, liquid blood. She gets cramps in her fingers and she holds them asunder. This distresses her more than the hemorrhage.
- Compare: Viburnum op (1st month); Apis & Kali carb (2nd month); Crocus, Sabina, Thuja (3rd month); Sepia (towards end of pregnancy)
- Secale has very important gastro-enteric symptoms.
- It produces violent diarrhea. The stools are watery, offensive, yellowish or greenish, gushing, sometimes involuntary.
- In the abdomen we have flatulence with a great deal of rumbling. The pain in the lower belly is sometimes so great as to force the patient to lie down in bed all huddled up like a bundle.
- The thirst is unquenchable. He wants cold, refreshing drinks, such as lemonade and ice water.
- Appetite is increased even in advanced cases.
- Tingling and formication all over the body.
- It is especially useful in long interminable summer diarrhea in scrofulous children which resist every remedy. As a consequence, the child turns weak and emaciated.
- It is more often indicated in the latter part of the cholera or AGE (Acute gastroenteritis), the stage of collapse.
- The vomiting is generally over by this stage or if present, is painless, without effort and followed by great weakness. The whole body is icy cold to touch but the extremities are particularly so; but in spite of this superficial coldness the patient complains of great heat and burning inside. Heat makes him feel decidedly worse; consequently he shows a great aversion to being covered.
- Compare (for cholera or AGE): Arsenic, Carbo veg, Veratrum album, Camphor
- Secale is a remedy that is called for in all types of fevers with a tendency to typhoid and typhus. The three stages of chill, heat and sweat are very pronounced. It is ushered in with violent shaking chills. The body feels intensely cold to touch, particularly the face and extremities. The thirst is unquenchable. The lips bluish and the tongue deadly pale.
- Compare: Camphor, Menyanthes, Nux vom, Phosphorus, Verat alb
- As if intoxicated while undressing.
- As if eyes were spasmodically rotated.
- As of a solid plug in nose.
- As if tongue paralysed.
- As if there were some resistance to be overcome in speech.
- As of a heavy weight in stomach.
- Region of stomach as if contracted.
- Anus as if locked up.
- As if testes being drawn up to inguinal ring.
- Uterus as if burnt.
- As if contents of uterus would fall forward.
- As if soft air were creeping through back.
- As if sacrum would be forced out.
- As if something alive was creeping under the skin.
- As if fingers asleep.
- As if limbs had been a long time in hot water.
- As if sparks of fire were falling on different parts.
- As if mice were creeping under the skin.
- Fuzzy feeling in limbs.
- Arsenicum album
- Similarity with emaciation, GIT effects, restlessness, burning, mid day mid night aggravations, anxiety, gangrenes etc.
- It is also important to note that though all vegetation is damaged with arsenic toxicity, rye grows abundantly under its influence!
- In labour, Cinnamon (Henry Clay Allen: In post-partum hæmorrhage, Cinnamon increases labour-pains, controls profuse or dangerous flooding, is always safe, while Ergot is always dangerous.).
- Cold skin, cannot bear to be covered,
- > Uncovering, , Calc., Camph., Fer., Iod., Lyc., Pul., Sul., Ver.
- Diabetes, Plumbum.
- Old persons, Conium with twitching, coldness, chilblains, chorea.
- Follicular pharyngitis, bich.
- Cold surface, sunken, pale face, blue lips, tingling in limbs, speech stuttering,
- Action on blood-vessels, c.
- Diarrhœa discharged with great force, , Crot. t.
- Burning feet, cramp in calves,
- Eyes < from warm applications ( > cold washing).
- Spastic paralysis, Lathyrus sat.
SOME MORE CLINICAL EXPERIENCES
- A 36 years old lady consulted for protracted meno-metrorrhagia after undergoing MTP (medical termination of pregnancy) with D&C (dilatation and curettage). Her USG revealed RPOC (retained products of conception), for which the gynae had advised repeating D&C. Since the patient was unwilling to undergo the procedure, she consulted for any possible alternative homoeopathic treatment. She also complained of feeling of intense heat, even though it was winter, which was unusual for her. Secale corr 30, tds for 3 days not just promptly stopped her meno-metrorrhagia but USG repeated after the following (regular and normal) menstrual cycle revealed clearing of RPOC.
- A scrawny lady in her mid-sixties consulted for persisting IBS (irritable bowel syndrome) with PGOA (primary generalised osteoarthrosis). She was anxious and restless and explained that every doctor had advised her to undertake thyroid investigations when she mentioned that over the last 10 years, post menopause, she had grown leaner (lost nearly 20 kgs) and at the same time lost her sensitivity to cold, but her serology was always within range. Though she felt warm all the time, her bodily surface was always cold to touch. Ascending LM potencies of Secale corr over the following few months relieved her of IBS, with which she had suffered for nearly 2 decades and also relived the pains and stiffness of PGOA making her life comfortable. Her weight also improved to 45 from 40 kgs during 6 months of homoeopathic treatment.
- My teacher prescribed Secale corr 200, one dose, to a septuagenarian lady with a history of CVA, who presented with 6 weeks old hemiparesis with wasting of muscles on the ipsilateral side and incontinent bowels and urine. She went on to make a fine recovery within a few days of the prescription without any repetition.
- De Costa, C. (2002) Anthony’s fire and living ligatures: a short history of ergometrine. Lancet, 359, 1768–1770.
- Haarmann T et al. Ergot: from witchcraft to biotechnology. Mol Plant Pathol. 2009 Jul; 10(4): 563–577
- Piquemal R et al (June 1998). Successful treatment of ergotism with Iloprost- A case report. Angiology. 49(6):493-497
- Plumvee KH. Clinical Veterinary Toxicology- Chapter 23-Mycotoxins. 2004. Mosby as accessed online at https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/ergotism
- Cook R (1994). Acceptable Risk. Berkley Books, NY.