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Case Study

Learning Through Clinical Cases
Dr Niranjan Rangoonwala
'Verat-alb / Verat-alb

Case 1:
[20-10-94] Male aged 40 yrs. He has a grocery store in a small town, and is busy attending to his customers whole day.
His chief complaint was pain in left heel, left knee joint since 2 years.
> by hot application: Diagnosed RA by physician.
Associated complaints were:
- Chronic cough and Coryza
- Difficulty in breathing
- Numbness and burning soles > cold
- Burning urination
- Pain in penis during intercourse
- Epistaxis
- Anxiety [Gabhraman] > open air with coldness of body.

Physical Generals:
- Desires- sour++, salt++, pickles+, spicy+, cold drinks+, ice cream+.
- Perspiration +++
- Wants door and windows open
- Desires fan +++
Past History:
1. Diphtheria - in childhood
2. Jaundice
3. Rt Chest Pain
4. Hypertension
5. Cracks in soles

- Irritable
- Miser as told by wife
- Weeping disposition, can't see suffering of others
- Cannot remain alone but does not speak in company
- Fault-finding and dominating - in work.

Symptoms Considered For Evaluation:
- Irritable
- Censorious
- Haughty [always believes what he does is right]
- Weeping disposition
- Cannot bear to be left alone, but does not speak in company.
- Desire, sour + salt

20-10-94 Verat-alb 200 (i)
29-10-94 Placebo
12-11-94 Better in heel and knee pain
24-11-94 Placebo
7-1-95 Cough increased due to dry cold with Bryonia 1M-I
20-1-95 Placebo
1-3-95 c/c recurred Verat-alb 200 I which relieved the complainant till date. 

Case 2:
27-3-95: A 50 yrs spinster, a Professor in a college came with c/c of pain right arm with numbness for 2 months. Feverish with shivering in rt arm every alternate day. ODP - In August '94, she had Falciparum malaria which lasted one month. Since then she is having feverishness with shivering and loss of appetite.

Associated Complaints:
- Vitiligo - whole body since 1981. This appeared after suppression of skin disease.
- Decrease in body weight
- Constipation
- Diarrhoea during menses
- Menses profuse

For everything in her talk she showed her faith in God. She is entirely dependent on God. She 'says' whatever God does is right whether we consider it as right or wrong'.
At every untoward circumstances and when depressed, she used to pray. Her mother died in June '94, due to which she became depressed.
THERMAL -Hot patient.

Past History:
Typhoid 1961 Repeated malaria skin disease
Symptoms considered for evaluation:
Very religious
Diarrhoea during menses
Hot patient
Remedy considered was Verat-alb.
But considering the ODP of P Falciparum in Aug '94 and origin of the disease since then she was kept on Nat-mur to give her a feeling of relief.
27-3-95 - Nat-mur 30 (II)
14-4-95 - feels > in arm pain, appetite increased 
Constipation > Placebo
9-5-95 Verat-alb 200 (I)
10-5-95 Fever 102 degrees with chill. Placebo
12-5-95 Fever 104 degrees with chill. Thirst for cold water and desire sour.
Verat-alb 200-I
14-5-95 No fever Placebo
3-6-95 Vitiligo - slight improvement esp. of upper limb Placebo
1-7-95 No fever, pain in right arm slight, Placebo patient is healthy till date.

Conclusion: Combining cases 1 and 2 we can evolve the mental symptoms of Verat-alb as follows:
- Egotism
- Haughty [arrogant, proud]
- Censorious [fault finding]
- Irritability
- Desires company
- Cannot remain alone but when in company does not speak
- Religious
- Praying
- Weeping disposition
- Constant activity
- Righteousness

Physical Generals Evolved Were:
- Diarrhoea during menses
- Constipation > during menses
- Desires - sour + salt, pickle, cold drinks, ice-cream
- Sweat and menses - discharges are profuse.
Above two cases teach us two persistent points which are seen in all the cases we tackle.
One - To study and understand the patient as a whole 
Two - To remain unprejudiced with respect to diagnosis as well as remedy.