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Case Study

Her Periods Relieve Me
Dr Parinaz Humranwala

On a regular follow-up visit, one of my patients candidly said 'Doctor, I am better and must thank you, but let me also bring it to your notice that my daughter has been under your treatment for the last two months, and I as a mother do not see any change in her.' Quickly I opened up her daughter's case and was surprised to note from my notes on the last follow-up, which read 'Diarrhoea before menses >, Eruptions >>, Menses still heavy.' "Yes", "said the mother," she is better with her physical complaints but her temperament shows no change. Possibly she has not described herself well.' Softly she added 'I will tell you about her nature but do not mention my name not mention my name nor give any clue that you know of these symptom on her follow-up visit late this week. [Surely the mother seemed scared of her daughter.] Doctor! My daughter [I began to note her words on the case sheet] No! Please do not write here, what if she reads it, there will be a riot at home. [I rested my pen on the table and began to hear her intently.] Her anger cannot be described in words. If angry over a small matter she can go to any extent. The other day, her brother forgot to tell her about her friend's call in her absence. As a consequence she threw my son's watch from the second floor. She is extremely possessive of her boy-friend and if she sees him talking to another girl in a friendly manner, the poor boy is almost subjected to torture. She once bit him in a fit of anger. He loves her earnestly and hence forgives her, but I do not know how long he can tolerate her behaviour. We have always marked that her deeds of violence and her irritability are more pronounced before her periods. Everybody at home heaves a sigh of relief when she announces she will not go to the temple, which is a part of her daily routine, as she has begun menstruating. What I dread the most is, she is getting married in the month of December. As her menses are clashing with the marriage and honeymoon, she has decided to take pills to postpone her periods. 

I am sure that her temperament will soar up higher with every single day of postponement, and I cannot imagine her behaviour during those important days. The Gynaecologist, whom we consulted, diagnosed her problem as Pre-menstrual Tension and prescribed some tablets which did not help.' Requesting me not to disclose her contribution, she left. 

The case history in brief given on the first visit by the daughter is as follows:
Diarrhoea and frequency of urination before menses every month before her periods. She dated her problems to the induced abortion she had five years ago.
Menses early, plenty of clots and very heavy. Leucorrhoea often.
Swelling of fingers worse before menses.
Early graying of hair with one strand absolutely white in the parietal area, which she covered with the use of henna making it appear as if it was highlighted.
Eruptions on right ring finger which appears especially when constipated.
Recurrent migraine < before menses. 
Scanty urine, due to less intake of water, would bring on acne.
Coldness of palms and soles < summer. 

Stays with her parents and brother and is to be married soon. Feels insecure and is very possessive about her boy friend as her mother confirmed. Gets angry and can even break things in a fit of anger. In a fit of violent anger, she once stabbed her brother with a fountain pen even when she was just 12 yrs old. Depressed often and would continually sigh during the interview, but there were no tears in her eyes. She did not want to discuss herself in detail and preferred my questioning on the physical symptoms. She had dreams of robbers. Loved to eat spicy food. 

P/H : Varicose veins; Fracture in skull due to injury; Dysentery; Eruptions on ring finger suppressed with local ointments.
F/H : Father-Lumbar spondylosis. Grandmother-Diabetes, Cancer.
Mother- Dental Problems; Acidity.
Ambithermal more towards hot.
Based on the history given by her minus the preceding symptoms given by her mother, I was led to prescribe Ignatia 1 M and later 10M. {Sighing; inward grief; violent anger with deeds of rage; and contradictory physical symptoms} 

After the mother's account I gathered that the girl was physically better but mentally absolutely the same. This meant I was possibly wrong with my prescription. It then dawned on me that the girl's violent anger needed to be given more importance. The remedies which came for consideration mainly were Merc-sol,Lachesis, Nitric-acid, and Patina. 

The impulsive anger of Merc-sol did exist but then I would only be covering one aspect and not covering the physical symptoms. She did have the degree of violence of Nitric-acid but there was no anxiety and it covered few menstrual symptoms of the case. The impression of haughtiness, the impulsiveness and her hair gave her the look of being a Platina. The girl lacked self-control and hence, in her fit of anger, would get violent. Her physical symptoms and her behaviour pattern changed before menses and with the appearance of the menses even the family members were relieved. Scanty urine would bring on acne and constipation would lead to skin eruptions-hence the generality 'discharges ameliorate' needed to be given importance. The propensity to sigh; dreams of robbers; possessiveness; religiousness and the character of menses along with the above described symptoms led me to prescribe Lachesis 200[1 dose]. After my change of prescription her follow-up revealed that her physical symptoms showed absolutely no change for the better, though her mother reported her to be calmer. [In fact the response to Ignatia seemed better at the time.]Only a moth later she reported feeling better with her diarrhoea, frequency of urine and her migraine. Menses were regular with very few clots. [Boericke describes the duration of action of Lachesis as 30 to 40 days. Often the action of a remedy starts in the third week and does not show any change earlier to it and the golden rule 'wait and watch' becomes a must.] 

In retrospect, when I glanced through the spectacles of experience, I summarised what this case had taught me. One must never feel hurt, nor disappointed it a case is not improving and is brought to your notice by the patient or a family member. Instead take the help of the family member to know a few more details about the patient and you will unearth the remedy, which is the similimum.