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Case Study

Psoriasis and Sepia - an Understanding
Meena Mankani.
` Sep.

A 36 year old, fair and balding lady, consulted me on 17-1-91 for her 7 years standing psoriasis on her scalp, knee and elbows. The multiple courses of cortisones had failed to relieve her, and Homoeopathy was being tried as a last resort.

Accompanied by her mother and her husband, she wept throughout the consultation since the itching and hair fail are "driving me mad and death seems more comforting than living with this misery". The disease picture that emerged was as follows:

Being the plain looking eldest daughter of a well-to-do businessman, she always lived in the shadow of her beautiful younger sister. Right from childhood, she faced constant comparisons with her sister. Wherever she went she always felt extremely humiliated. This created a feeling of being unloved, and a burning desire to prove herself better than her sister in every other aspect of life.

She would always be on the look out for occasions wherein she could let her sister down and prove herself to be "expertly faultless" and an "unbeatable master of all trades". She would then revel in the halo of praise and admiration that would be showered on her.

These acquired skills helped her to become very famous and get a very suitable mate. Thus she got married at the age of 25 years to a rich and good looking young man.

She enjoyed her married life until the arrival of her son two years after marriage, after which her life became "a drudgery". Four years hence another son arrived and that made her life "a hell". She said, "Doctor, one should never have children. My first one was a mistake and the second a blunder". She never hugged, cuddled or kissed her children. She generally spoke to them in harsh tone and was a very strict disciplinarian.

But she pampered her husband greatly and would not leave a single stone unturned in order to please her husband. She would work hard round the clock to please her in laws and all of her husbands friends and relatives, so that her husband could be proud of her. Her husband praised her for this.

The only thing that she dreaded was anyone pointing out any mistake of hers. That would humiliate her no end.

She attributed, the psoriasis to the tremendous tension that she underwent after her second delivery on account of her great hair loss. Now she almost looked bald and was an object of ridicule wherever she went. In her own words, "My skills cannot cover up my ugliness. I feel so miserable, I hate anyone addressing me as "Oh! see this poor bald lady". Death is preferable to this humiliation".

Past History:

  1. Malaria at 10 years.
  2. Jaundice at 14 years.
  3. Acute glomerulo nephritis at 16 years.
  4. Acne between 15-19 years, always agg. before menses.
  5. Appendicectomy at 21 years.

Family history:

Mainly diabetes, hypertension, arthritis, eczema and renal calculus.

Physical general and particulars:

  1. Appetite: Good. Gets headache from hunger (2) ? by eating (3).
  2. Thirst: 9-10 glasses - day.
  3. Cravings: Spices (3), eggs (2), curds (2), and fruits (2)
  4. Aversions: Nothing particular.
  5. Urine: Involuntary urination on coughing or sneezing since past 7-8 years.
  6. Stools : NAD
  7. Sweat: Scanty - especially on axilla, very offensive (3) and leaves indelible yellow stains (3).
  8. Sexual Sphere : Normal
  9. Menses: Menarche at 13 years and ever since gets severe headache just before the flow and has to take medicines.
    : Irritability (3) before menses.
    : Flow very scanty and leaves indelible stains (3).
    : No h-o any abnormal discharges.
  10. Sleep: Disturbed due to her anxiety over her baldness and itching. Keeps on tossing and turning. On refreshed on waking.
  11. Dreams: Frequently dreams of being deserted by her husband, and leaving her for another young beautiful girl; wakes up with a jerk.
  12. Chilly patient (2); always gets cracks in the soles in winter since childhood.

Analysis of the Case:

It is often found that the words a patient chooses to express his - her discomfort beautifully reflect the whole of the internal dyscrasia. During case taking the patient used the words :drudgery", "mad", "hell", "misery", "blunder", "humiliation" and "ugliness" to describe her distress. Her selection of these terms indicated Her Perception of her situation as an extreme desperate one needing help. As she had said, "Death is anytime desirable than facing this drudgery and humiliation". So the first rubric that is central in this case is

  1. DESPAIR, existence, about miserable (SR I 392) And the only remedy given is SEPIA.
    Secondly, one of the most important characteristic expressions that persists right from her childhood is her morbid sensitivity towards any criticism - real or imagined; since any such remark would humiliate her and also bring forth to her consciousness her deep rooted insecurity. She had always felt unloved as a child and even now does not feel secure with her husband as is reflected in her concern over keeping him enticed and her recurrent dreams of being deserted by him. This extreme sensitivity is well explained by Clarke in his Dictionary of Materia Medica on page 1161. It reads, "she is very sensitive and must not be found fault with".

    And it is for this very same reason that she toils round the clock to never fall short of being a "Master of all trades". Being extremely efficient makes her acceptable and secure and saves her from the dreaded feeling of humiliation.

    So we take the rubrics -
  2. Forsaken feeling, beloved by his parents, wife, friends, feels of not being (SR I 547)
  3. Anxiety, fear, with (SR I 76)
  4. Fear, humiliated, of being (SR I 505).
  5. Positiveness (SR I 798).
  6. Industrious (SR I 630).
  7. Contradiction, is intolerant of (SR I 184).

    Then we also have -
  8. Abrupt, harsh (SR I 1).
  9. Weeping, telling of her sickness, when (SR I 1088).
  10. Fear, society, of his position in (SR I 523).
  11. Indifference, children, to her (SR I 612).
  12. Unsympathetic (SR I 1054).
  13. Irritability, menses, before (SR I 667).
  14. Jealousy, women, between (SR I 677).

At the physical level we have,

  1. Head, hair, baldness (KR 120).
  2. Head, hair, falling, parturition, after (KR 120).
  3. Head, pain, menses, before (KR 142).
  4. Head, pain, eating, amel (KR 139).
  5. Food + drinks, spices, desire (SR II 272).
  6. Perspiration, axilla, offensive (KR 878).
  7. Perspiration, wash off, difficult to (SR II 514).
  8. Menses, scanty (SR III 564).
  9. Skin, cracks, winter in (KR 1305).
  10. Skin, eruptions, psoriasis (KR 1316).

Prescription and Follow-Up:

So she was given one dose of SEPIA 1M on 21st of January 1991 followed by placebo. In a span of 4 1-2 years, she had been given 14 doses of SEPIA from 1M to 50 M potency. Right from the very first dose, her psoriasis got well controlled and for the past 1 1-2 years there has been no trace of it. Anyway, one has still to wait and watch before claiming it to be cure. The growth of her hair improved and at least now she doesnt look "ugly" anymore, and that has further lessened her feelings of misery and desperation. Her children, though now not a "mistake" and a "blunder", but yet are not very dear to her. How far the similimum is capable of altering the deep in-born attributes of a person is yet to be seen in her.

Some Remarks:

I have often seen in Sepia patients, that no matter what favourable circumstances they are placed in, any sight stress or minor ailment puts the in a great misery or desperation. A woman having ten servants may find it a "drudgery" even to order them and feels "why dont they do their work themselves?"

So, not withstanding the typical picture of SEPIA of a middle class sagging and slogging mother of ten crying babies who gets desperate at every single thing, I have seen ladies from the most luxurious classes getting disproportionately desperate and hence benefiting from SEPIA, whom one such patient termed as a "wonder drug".