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Case Study

Irritable Bowel Syndrome-a few cases
NATIONAL JOURNAL OF HOMOEOPATHY 2004 Mar / Apr VOL VI NO 2.
Dr Adil Chimthanawala
'Aloe / Sulp / Lil-tig / Podo / Puls / Lil-tig

"Irritable Bowel Syndrome", brings to mind a host of successes for this so-called vague syndrome. It is a Psychosomatic disorder manifesting primarily via GIT in the form of recurrent episodes of loose motions. The signs & symptoms are wide, vague and vivid. The Symptom syndrome is diagnosed by the process of elimination of other differential disorders as amoebiasis, giardiasis, Ulcerative colitis, Koch’s abodmen etc. The Miasmatic Diagnosis of this disorder is obviously Tubercular - Psorosyphilitic due to its characteristic features viz. recurrence, erraticity of symptoms, changibility and restlessness.

In my practice, patient age group-50 years. Predisposition to psychiatric problems and health care seeking behaviour.
Pathophysiology: "Body mind" interactions results in altered motility of the gut- hyper responsiveness of the gut to minor stimuli (similar to bronchioles in Asthma).

Certain life events which leave a deep emotional impact as a sense of "loss" or "injustice", threat to one’s own identity, sexual or physical abuse, unwanted / unhappy marriage, unwanted child birth, etc act as exciting and maintaining factors. The patient has difficulty in coping with the loss and this starts the cascade of events that ultimately leads to IBS.

I am citing 3 atypical cases of IBS with varied clinical presentations. All had come to different OPD’s (Paediatric, Gynaecology and cardiology) but had IBS. They all responded to a single remedy (although lesser used). By such a workup one can study 3 different states of disposition as well as 3 varied aspects of a single remedy. The constitutional remedy so selected was after the apparently indicated remedy had failed to yield expected results.

Cardiophobia with Chronic Loose Stools
48 yr Male- Sales executive presented on 4/8/02 with
1. Systemic Hypertension - 8 years
AF Death younger Br of MI.
Patient was constantly worried about having a heart attack > when occupied.
Occ Palpitation + burning palms & soles.
Chest Pain extending to Rt Arm
2. GIT complaints - 12 years
Stools loose, 3-4/ day, mucus+++, unsatisfactory, occasionally passage of blood.
Bloating < meals occasionally involuntary. Urge > urination.
Temperament:
 soft spoken, apprehensive, mild, worrying nature. Perception good, short tempered, Anxious about his complaints.

Physicals Generals
Thirst +++; > fresh air
Past History: T cruris, roundworms
Family History: Mother - died of pleurisy.
Father: IHD, HT.
Had taken Nux-vom, Carbo-veg, Lyco, China etc.
Investigations - Repeated Stool examinations - Nil.
Colonoscopy - N.
ECG & 2D ECHO - N.
O/E - P-80/min, reg, B.P- 120/90mmHg, No Pallor/ Icterus. Heart Sounds-N, RS clear, CNS-NAD.
Per Abdomen- soft, Vague tenderness +.
Liver/Spleen/Kidneys - Not Palpable;

Management
4/8/02 Aloes 200 TDS x 3 d
14/8 Stools invol on passing flatus. ++ Aloes 1M TDS x 3 d 
Early morning urge to stool >
25/9 Stools - mucus ++. invol Sulph 200 TDSx1 d
Early morning urge >. Burn palms ++ SL x 1 mth
3/10 Partial > all complaints. Sulph 1M TDS x 1 d
Anxiety +++, Itching groins ++ SL x 1 mth
P reg 90/min, BP 130/80 mmHg
P/A - soft, NT, L/S NP
4/3/03 Reported after 4 mnths.
Nux-vom
 1M/ TDS x 1d
All abd comp +++ SL x 1 mth
H/o Hosp for HT + U. angina Amyl-n Q sos
ECG: Anterior Wall ischemia, ECHO-N, Coronary Angiography-N Aspirin Omit
On Sorb, ASA. GI symp < Aspirin
Anti-Hypertensives contd
10/4 Rec. Angina ++ > sorbitate Lil-t 200 TDS x1 d
Bloating, Stools loose; mucus+++. SL x 15 d
Involuntary on passing flatus+.
Case reviewed in clinical meet
:
Apprehensiveness ++, worry +,
Constant dwelling on brothers death +
Anxiety of his own life after death. Religiousness ++.
27/4 Mental calmness ++, anxiety about his health> SLx15 d
Religiousness > Borborygmi / Eructation/ Flatulence ++++, Stools N, No Angina.
22/5 Pt > in all respects Anti Anginals Omit
Calm, No rec thoughts about salvation SL x 1 mnth
Stools N. Flatulence >>
Eructation>> BP 130/84mmHg. Amlopres 2.5mg
4/7/03 P -92/min. Reg good vol BP 130/84
PA - soft non tender, L/S NP. HS pure, RS clear
S. creat- 0.9mg/dl. Bl. sugar(R) 105 mg/dl.
ECG - WNL, 2D ECHO - normal study
Pt under follow up and is well settled.

Discussion:
1. Aloes was the 1st choice-Stools loose, 3-4/ d, mucus+++ with flatus, early morn diarrhoea.
2. Sulphur was given-Diarrhoeal tendency, mucus+++, worrying nature. Perception ++, short tempered,
3. Lilium-tig selected on Apprehensiveness, worry +, Constant dwelling on brother’s death +  Tormented about salvation. Religiousness ++. Nervous, Anxiety heart disease, consolation dislikes, thirst ++, Stools > occupation.

Masturbation with Recurrent Colics
Ritika- (1 of the twins), a 7 years old girl studying in Standard III was brought to the OPD by her mother on 10/3/03 with C/o

  1. Freq rubbing of genitals < night & before strangers.
  2. Urine frequency ++, urge uncontrollable, soils clothes.
  3. Recurrent abdominal colic, shifting pains > rubbing, moving
  4. Stools - frequency ++, semisolid < night. Stool examination - mucus ++

Mentals: Irritable, Contradiction <. Fidgety, Cranky, Consolation <. Cannot stay alone. Sibling envy. Violent Anger - beats the other twin sister.
Appetite / Thirst ++++
Craves -cakes, non- vegetarian food.
Micturition - 10-12/day, 1-2/nights
Sleep - restless, 7 hours/24hours
Past History - Chicken- pox
Family History - Mother: asthma, Father: Renal stones, PGM-died Ca Cervix
10/3/03 Origanum 200 TDSx1d
SL x 15 days & Psychotherapy - parents
20/3 Rubbing of genitals > Origanum 1M 3 doses
Stools, urine same SL x 2 wks
17/4 Mentals unchanged.
weeping & anger fits ++ Lil-tig 200 TDS x 1d
Stools, urine same SL x 1 mth
27/5 Anger fits >, less irritable SL x 1 mth
Conc +++studies,
Stools freq decreased, N consistency
30/6 Stools normal, rubbing occ Lil-tig 1M 3 d SL x 1 mth
11/7 All comp relieved SL x 2 mth
Follow-up ct.
Lil-tig
-rpt after 1 mth . Pt. >> all respects.

Discussion
Drugs thought - Hyos, Bufo, Medh, Ustilago & Zincum.
1. Origanum: on Excess aroused sexual impulses. But gave little relief.
2. Lil-tig-Irritable, contradiction < consolation <, fidgety, Envy, cannot stay alone, violent anger, Weep+++; Masturbation (rubbing genitals). Shifting colic. > rubbing, moving. Stools & mucus. Craves meat.
Note - Hyos: for insanity & Lil-tig: more marked for habits.

Uterine Prolapse with Flatulence
A Female aged 38 years. Mother of 4 children [all FTND] came with.
1. Prolapsed uterus - After 4th Child birth (forceps delivery) - 5 years ago H/o delayed labor in 3rd & 4th child < defecation, has to support the prolapsed parts with hand > supine. Has been advised hysterectomy several times but refused.
2. Menses scanty, clotted < sitting. Itching genitals ++; Leucorrhoea - acrid, profuse, thick < menses.
3. Continuous dragging pain in the lower Back.
4. Stools - pellet like http://www.njhonline.com/images/rtarrow.gif loose, urge uncontrollable, Flatus++++ - 5 yrs.
S/o Fullness - upper abd < before meals, dyspepsia.
Mentals
 - Depressed, Impulsive, Critical & Snappy; Constantly Busy.

Life History - Patient is the only child of wealthy parents. She had a Love marriage with a mediocre - Medical Representative at the age of 25 years. H/o Pre & Extramarital Sex ++. Husband has a touring job.
P/G Appetite:++. Desires= Pickle.
Thirst ++. Micturition - N
Sleep-Restless. 6 h/24h, walks in sleep.
Menses-Reg, 2/22, scanty

Family History: PTB (14yr ago); M-Lumbar Spondylosis.
O/E - P-100/m. reg. B P- 130/90mmHg
No Pallor. Systemic N
PV-Uterine prolapse Grade II, Cx-erosion + +
Investigations
 - Stool N, Bl Sugar -96mg/dl, PAP -ve. Sigmoidoscopy N. PAP smear - ve (16/8/98)

Management
18/1/99 Podo 200 3 doses SL x 1 mth
22/2 Fullness >. dyspepsia + SL x 1mth
Stools - loose. Urge same.
Leucorrhoea > but pruritis +++
26/3 Menses scanty, clotted < sitting.
Puls
 200 3 doses
Lower backache, Leucorrhoea ++ SL x 1mth
Itching genitals ++. Stools - loose.
23/4 Leucorrhoea >, Itching same SL x 1mth
Stools - loose. Backache ++. Mentally - restless
22/5/99 No change Lil-tig 200 3 d
Mentals ++ SL x 1 mth
25/6/99 Leucorrhoea >, itching >>
Backache, Prolapse > defecation.
Menses - flow +, red, clots >. Mental - restlessness >

Discussion
1. Podophyllum - Ut. prolapse, Loose stools, Fullness, dyspepsia
2. Puls- Menses scanty, clots < sitting, Lower backache.
Both these drugs did not give expected results. Other drugs : Sepia, Murex, Platina &
3. Lilium-tig: Constantly busy- workaholic, sex desire ++, Impulsive, Ut Prolapse,
Stools - changing consist, urge uncontrollable, Freq. urination. Leucorrhoea, Itching Genitals+++