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Case Study

The Angry Lady
Dr Suneetha S Tripathi
'Calc-carb / Puls

Pre-menstrual syndrome is a condition where 8-10 days prior to onset of menstruation, some females suffer from unpleasant sensation and complaints ranging from emotional upsets, irritability, weeping, anger, depression to physical complaints like:
1] Heaviness and pain in the breast
2] Nausea and vomiting
3] Constipation or diarrhoea
4] Weight gain due to fluid retention 
5] Insomnia
6] Headache, bodyache
7] Tiredness, fatigue, weakness
This syndrome can be rapidly and gently dealt with by our Homoeopathic medicines. Following 2 cases demonstrate this. 

Case 1: The Angry Lady
This case was taken on 29/9/92. Mrs S G K aged 38 yrs, complained of the following:
5-8 days before menses, she is irritable, angry and feels hurt even on simple issue. Sensitivity is heightened to remarks and weeps often. Complaint since 3-4 yrs. < During menses: nausea, vomiting, bodyache, even water not retained - vomits immediately.
Weakness++, Loss of appetite+
Menstrual History : Regular, 4-5/30, red in colour, odour +, no clots, stains + delible. Menarche at 15 years of age LMP 5/9/92. 

Other Complaints
Head ache < draft3 + fan 3 +, > tying2 hard pressure
Flatulence > mixture of salt and garlic
Heaviness and bloated feeling < potatoes.
Leucorrhoea < after menses for 3-4 days - watery thin, bland not offensive. 

Physical Generals
Thermal : Likes winter
Bath : Hot water throughout.
Covering : One blanket in winter, none or thin sheet in summer 
Fan : On speed 3 in summer and 0 in winter. Sleeps away from fan because of headache.
Wool : Sweater + shawl, since feels very cold with 3 chilly, 1 ambi, and 1 hot response, over all patient is chilly.
Perspiration : Not much even if no fan. Sweats in axil lae; no smell, no stain.
Appetite : No specific craving or aversion. 
Bowel/Bladder - NAD
Sleep : Good but if disturbed, then can not sleep for 2-3 hours.
Obstetric History : 2 FTND -No trouble. 

Mind : Patient comes form a middle class family. Husband owns a grocery shop. Elder son, 22 year, is working with father; 1 son and 1 daughter are studying. Cordial relations with everyone calm and quiet, except during menses when she gets upset and irritable. Occasionally when she gets irritated, cools down within minutes, and does not spoil relations with her daily routine. At her parents' place, there are 3 brothers and 6 sisters. Mother has similar complaints. No other family history of significance. 

Physical Examination
WT: 52 Kg NAILS: Pallor +
SKIN OF FACE: Wrinkled +
BP: 110/70; RS / CVS: NAD
While examining, patient complained of burning sensation in feet, since 2-3 yrs. Nausea and vomiting while on traveling by bus (motion sickness).
In this case, since mental symptoms as well as characteristic particular symptom were present. Kent's approach was taken. 


KR 59

Irritable < BM

KR 77

Sadness < BM

KR 508

Nausea < DM

KR 135

Headache < Draft

KR 722

Leucorrhoea < AM

KR 1013

Burning feet

KR 509

Riding in carriage < Nausea

KR 534

Riding in carriage < Vomiting

Drugs featuring after repertorization were:

















Calc-carb was having the maximum coverage and overall the picture was matching i.e. a lady easy going with no problems in relationship, reveals her adjusting and compromising nature and led to its selection.
Susceptibility was good. Sensitivity was high.
Therefore Calc-carb 200 OD, schedule was adopted on 29/9/92 patient was given Sac-lac for 3 days since working of the case was not done.
2/10/92 Calc-carb 200 [1] stat. Placebo TDS for a week.
10/10/92 - LMP 6/10/92
No premenstrual complaints. There was no nausea, vomiting or mood changes. This time patient was absolutely comfortable. Placebo for 7 days.
17/10/92 - C/o fever, nausea, vomiting, headache, backache with dryness of mouth, dry cough, thirst increased for cold water 2 glasses 1 hourly; patient was feeling hot.
Patient was given Bryonia 30 TDS, for 3 days and she reported after a week that she was much better.
Since then patient keeps coming off and on for acute complaints of backache, headache or URTI. Her acute totality remains Bryonia. After every acute, patient was given Calc-carb 200 and gradually built up to 50 M. Single dose schedule maintained.
Her main problem of PMS never recurred. After the last dose of Carb-carb. overall the patient is very comfortable.

Case2: The Weeping Doll
Mrs PGS, 36 years old, Gujarati female came on 1/3/95 with the following complaints:
Backache3, bodyache3, headache3, breasts tender2 
< BM: Since 4-5 days
Headache3 backache3 < DM
MENSES irregular since 6 months. 10-15 days early or delayed.
Duration: 3-5 days 2 pads/day
Colour: Dark red or blackish or pinkish
Stains: H/o indelible, now gets washed off
Menarche - 15 years of age; LMP 7/2/95

Other Complaints
GIT since 3 months Gases < sour.
Heaviness < spicy.
Burning > eructations
Hands, fingers pain < morning waking on 
Headache < BM3 < DM3 < Sun3
History : Koch's 15 years back. Typhoid 4 years ago.

Family History : Mother expired after her delivery; reason not known.
No other major illness.

Physical Generals
Perspiration :
 Face + no smell, no stain
Thermal : Sun < headache
Likes : Winter, fan and open - Hot
Covering : 1 blanket in winter, 1 chadar in summer.
Wool : Required sweater plus shawl.
Bath : Tepid throughout
Patient can tolerate cold but can't tolerate heat therefore patient is overall hot.
Appetite : Reduced since 2-3 months, craving seasoned food, including green chillies.
Bowel : N   Bladder: N
Obstetric History : 3 FTND
< During 1 st pregnancy - vertigo, morning sickness, oedema
Sleep : Good, disturbed due to noise.
Dreams : Occasional, frightful.

Life Space : Patient's story since birth is interesting. Her father, a married man, with a pregnant wife whose younger sister came to assist elder sister during pregnancy. After delivery, he happened to fall in love with his wife's sister and married her, inspite of his first wife being alive and healthy. Patient is the daughter of the first wife. Unfortunately patient's mother died after child birth. Patient was brought up by her step mother cum maternal aunt. Patient was brought up by her step mother cum maternal aunt. Patient was a very loving, adorable and obedient child, quite mild and adjustable. Hence, she naturally attracted love and gained sympathy from others, including step mother. Her step mother brought her up very lovingly, and so her childhood was peaceful and pleasant.

Patient's elder sister got married. During the wedding, patient came with her sister to her in-laws, and sister's cousin brother-in-law got attracted to patient's loving, sweet and adjusting nature and felt in love with her. He approached her and she easily yielded to him, even though he was 15 years older to her. This is how she met her Prince Charming and got married to him.

Then she faced the tragedy of joint family and torture of mother-in-law and her Prince charming, instead of supporting her, used to dominate her and at times even scold, shout and insult her. MIL used to make her work throughout the day without adequate food and rest even during pregnancy. While narrating these incidents she was in tears and she continued with her story after some consolation. Inspite on all this, now when her MIL is old and helpless, she looks after her and does all her routine work whereas other brother-in-law have separated from the joint family.

The present family situation: husband having lost his job, is doing some business. There is financial strain. 3 sons, 21, 18 and 17 years are studying and helping father in business. Rest of the family has separated. Patient's relation with everyone is good. She forgives the bad behaviour of others and keeps helping them.

Throughout the interview, there were many pauses due to her lachrymose mood, but every time after a word of sympathy she used to lighten up and continue. After the interview she showed me her previous prescriptions which were mainly iron tonics, Dexorange syrup, capsule Autrin etc. She also insisted on getting some nice tonic which will make her feel energetic. She also complained that she never gains sympathy of being sick since her relatives feel she is in good health. No one appreciates her internal sufferings.

Appearance : Average build. Ht 5' 2" Wt 50 Kgs.
Nails pallor + ; RS/CVS -NAD
BP 120/80 Throat/tongue - NAD
At the end of the interview, her insistence for tonic and her prescription of iron tonic clicked in my mind.

KR 486

Desires tonic

KR 1369

Abuse of iron

Puls is common in the above 2 rubrics. Her life-story too was a text book picture of Puls.
Quick reference to her characteristic particulars 


< BM
< DM 


< BM
< DM confirmed Puls


Retrospectively, Changeability is also seen at the level of menses where the 
1] Color of discharge is not fixed - blackish, red, pinkish
2] Duration is not fixed +/-15 days
3] Stains were indelible, now gets washed off.

The similarity at all levels and the high sensitivity, made me go for Puls 1M 1/3/95 Puls 1 M -single dose with placebo for 7 days.
10/3/95 LMP 4/3/95 Duration 3 days. Patient reported - < BM, < DM was > 50% in intensity
Headache, backache was there but tolerable GIT was > 3 since, intensity was better by 50% patient was kept on 1 dose per week for 4 weeks with placebo.
5/4/97 LMP 29/3/95 No < BM no < DM; GIT > 3.
Patient had spilled boiling water on her thigh and had scalds.
Patient wad advised Cantharis Q externally and Cantharis 30 TDS x 4 days. 10/4/95 burns > 2 recovering ++; Pain > 3

Since then patient has been reporting regularly. Her PMS is much better but she has proved her constitutional remedy by developing her dependency with the physician. She keeps reporting ever minor ailment to me and feels better with the acute medicines SOS. Followed by Puls whenever required.
A couple of times she required Lac-can 30 TDS with increase in thirst for large quantities of water [2-3 glasses] hourly. KR PG 529
Thus the weeping doll has become comfortable and neither she asks for tonic nor does she suffer without it.