Nasal Polyp: From confusion to clarity
NATIONAL JOURNAL OF HOMOEOPATHY 2004 May / Jun VOL VI NO 3.
Dr N L Tiwari
'Nux-v / Thuja

Master K, a 13 yr, Jain, studying in 8^th Std, was brought by father for problems in Rt nostril.
1) Nose block for last 6 to 7 yrs.
2) Running of nose through out the year, but < near seashore. No fever, no headache but feels tired.
3) Nasal speech.
4) For 3 months started green thick discharge and breathing through month.
Rx steroid (oral and topical) for three days.
The patient took all systems of medicine without relief. ENT surgeon advised surgery, as polyp is very large. The family wants to try Homoeopathic medicine before going for surgery.

H/O constipation from age 3 months to 3 yrs. Used to cry while passing stool; relieved after stool.

Childhood history
Normal delivery. Birth wt 7 ½ lbs.
Milestones
Teething: 6 to 7 months. Sitting: 4 months.
Walking: 10 months Talking: 1 year.

Mother’s History during pregnancy. Uneventful:
Post partum  no complications. Breast feeding adequate milk for infant.

Scholastic performance
Studying in 8^th std in English medium school. Performance: gets 1^st class in studies.
Interest in sports, cricket and foot ball. Enjoys music.
Physical description: Ht 5’ 6", Wt 51 kg, fair looking, brown hair, shy look.

Mental Attitude: Gets angry easily but cools down as easily. He is shy and obstinate by nature. He does not mix easily with friends, but he is not reserved ie he takes time. Once close to someone, he opens up.
Sleep and Dream: Occ talks, mutters in sleep since last 3-4 yrs. Snores. Sleep disturbed by nose block.

Reaction environmental factor: No specific reaction to change of weather but an exposure to sea shore gets nose block. Change of weather does affect him. Bath tepid in winter; cold in summer. Air condition gets nose block. Fan desires full.

Physical Examination
RS/ CVS/ PA - NAD, Nose - Polyp enlarged Rt nostril as if dropping out.

Life Space
Lives in joint family.
Father 37 yrs, runs the family business. PGF 75 yrs. Mother 35 yrs, house wife. Sister 10 yrs. Cousin Sister 23 yrs, Close knit family.
The patient is very attached to family specially father. Father is very anxious by nature and is very much worried about son’s health. Father also concerned about son’s shy nature, not mixing with friends especially girls.

Past History-Nil
Family History: PGF IHD. PGM-Diabetes, IHD, High BP.

Analysis of the Case
At the level of modalities and discharge:
1) Sea shore aggravation.
2) Discharge thick, yellow

Mental Attributes
Shy and obstinate nature, strong attachment to family.
Gets angry easily but cools down.
Sleep: Talking in sleep and snores.
Physical Generals: No special aversion and craving.
Remedies thought of
Calc-c: Shy, obstinate nature.
Kali-c: Strong attachment to family.
Nux-v: Gets angry easily and cools down fast. Constipation-hard stool > after Stool.
But no clear picture was available to come to the similimum. All patchy totalities.

The view of the case was taken as follows

Planning and programming
First prescription: Thuja 30
Constitutional: Possibly Calc-c / Iod. Kali-c.
Acute-Nux-v 30
Summary of line of treatment. First prescription given on 12/9/01. Thuja 30 3p and Placebo for one week.
Follow up criteria
Nose block- Nasal speech
Size of Polyp.
Snoring at night
Sleep disturbance.

12/9/01: CBC showed Eosinophils 09%, Nose block 10% better.
Patient kept on Placebo from 10/09/01 to 3/10/01. No spray was used (cortisones Nasal spray). Nose block same. No change in size of Polyp. No change in nasal speech breathing through mouth.
Thuja 30 7p daily HS.
31/10/01: Partial relief
The change in line of treatment. Thuja 30 1 p HS and Calc-c 30 next day. No relief.
31/10/01 to 21/11/01
05/12/01: Thuja 30 1 p HS Placebo for one week.
Kali-c 30 1 p HS
12/12/01: Nose block  but patient was on placebo.

The case was reviewed on 19/12/01 and it appeared that introduction of Calc-c and Kali-c proved to be fruitless. There was no registration of both the remedies.
19/12/01: There was partial response with Thuja 30.  
Planning and Programming : Thuja 30 daily single dose till the point of reaction.
Acute Nux-v 30 given as stock to be taken when there is acute exacerbation.
From 2002 to 28 Jan 04 the patient was under treatment for 2 years. Thus Potency 30 and repetition daily at bedtime and Nux-v 30.
Nose block became zero. Voice clear. Sleep good. Polyp Size reduced to minimum. ENT examination size of Polyp insignificant,

Learning from the Case
1) When case presentation is confusing or not clear, give importance to recent symptoms and consider them in making totality.
2) Do not introduce partial indicated remedy like Calc-c and Kali-c that will further confuse the case. It is fortunate Calc-c and Kali-c were withdrawn within week or two..
3) Miasmatic remedy itself can be chronic remedy or phase remedy. Thuja: anti-miasmatic / Inter current.
4) Nux-v will take care of acute exacerbation repeated as and when required.