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Case Study

Premenstrual Syndrome - Clinical Cases
Dr Satish Rana
'Lach / Lac-can

CASE : 1
A mother of three children aged 26 came for her chronic headache since last 12-13 years. In her younger age she used analgesics for the pain, headache and abdominal pains. But at the age of 20 yrs [i.e 2 yrs after her marriage] she was diagnosed by some allpath as suffering from Migraine and the course of medicine for the same was taken for 6-7 months without relief. Therefore, she again took to the analgesics like Novalgin, Baralgan etc. she is the 5th issue of her parents, being the youngest of four sisters and one brother she was given extra care and affection by the family members and parents.

At the age of 18 she got married to a rich businessman of Kapurthala. This was the feeling of the parents that marriage may relieve the problem, but this also did not help. Her menses are very regular 29 days/3 1/2 days, blood fresh, copious first day then normal bleeding for the rest of two and a half days. Her thermal condition is Hot. Frequently feels suffocated in crowd and closed room. She gave birth to her daughter at the age of 19 yrs, followed by the birth of twins , male children.

Patient is better by remaining in dark, away from any sort of noise, extremely sentimental, sensitive during headache. Type of pain is throbbing not better by any amount of pressure. Headache on every 3rd or 4th day of the month with marked periodicity.

On 23rd of July 1995, I prescribed Achyranthes 200, single dose, followed by SL, BD for 10d ays.
On Ayg2, she visited the clinic escorted by her husband with very severe headache. I tried to take the case again with the help of ehr husband. The husband narrated"she is almost dead with headache every month before her periods start." She usually complains of abdominal pain and her usual medicine for these days is Novalgin combined with Baralgan." "Yes" I can recollect shesaid that the headache started about 12-13 yrs back when I had menstruated for the first time. It is always attended with pain in abdomen, backache, white, creamy, leucorrhoea, and slight vertigo in general." My last but confirming question to the patient was "How do you feel on the 4-5 day of the menses?" "Absolutely better on the first day, when the flow starts, Doctor" was the answer.

Hesitatingly enough I popper a few globules of Lachesis 1M in the patients mouth and asked her to take the medicine i.e SL every 3 hrs. until relief and to report two days before the due date of next menses.

On the same evening the patient telephonically reported that she was alright after the first dose. Simultaneously bleeding started, but the haemorrhage was too profuse. I had asked her to report a day or two before the due date thinking that the relief could be due to the onset of flow. As the lady was young and the medicine I prescribed was a medicine of repute for the menopause. This was the reason for my hesitation.

During the next two months the patient did not appear. She visited me on 11th Nov '95 alongwith a patient suffering from the Uterine fibroids. She told taht she was absolutely o.k. since the day she took the last medicine. The basis of prescription were the following symptoms:

  1. Pulsating , head, menses, before KR 225
  2. Vertigo, menses, before KR 101
  3. Generalities, agg. menses, before KR 1373
  4. Leucorrhoea, menes, before KR 722
  5. Discharge, amel, B. B. 923
    After repertorisation I got Borax 4/3 and Lach 11/4

Author's Comment: 
In this case the main effective symptom is Discharges amel. under which came Cimi3, Lach 4 , Sul 4. The other kingpin symptom was type of pain, which is pulsating. The patient was warm but different from Sulphur, wanted to take bath every off and on. The lesson I learnt from the cse is Lachesis is NOT ONLY THE REMEDY FOR MENOPAUSAL STATES. It is of great help in young girls even where strong general symptoms indicate it.

CASE 2 :
Miss P Bala, 20, unmarried, tall, slim girl came to consult me for her morbid fear of downward motion. She was accompnying her mother. She did her Higher secondary after which she got training in tailoring, embrodery and now a days after compelting one year computer course is doing the job of a steno in a finance co. for a meagre amount.

While narrating her history she explained that she likes to be accompanied by some one always. "It makes me comfortable." She is much afraid of animals especially dogs. " A sort of fear anxiety or something like that occurs to me before an appointment always, although I have experienced the world around very much." When asked about the busines she is doing, "I did my tailoring and embroidery to earn good money out of that but I could not succeed as I lost interest in it. ; then I took the training of computer; this also did not help me:" she said "are you satisfied now?" No I shall leave the job. it does not interests me. While narrating her menstrual history she explaiend menses as a curse "Many a day before the actual starting of menses I feel pain in both breasts and a tightness of bra. I ffer very sad every month before the periods. First time , I menstruated at the age of 12. when I was in 7th std . Since then I freqently have to go to the bathroom for passing the urine but pass nothing. When asked if she ahs any fear of downward motion before her menses? She replied. my mother supports me down the staris. and very odd tos ay that my peon [male] assists me to get downstairs. Before menses, I feel some increase in the trouble, but there may be little relief after the start of menses.

On 12/12/95 ( A week before the due date) I prescribed a dose of Lac-can 10M and placebo for a week.
On 20/12/95 Reported considerable relief in fear of descending. The menses started on 17/12/95 with no frequent urge for urination. The breasts were painful but not that tight. Prescribed placebo BID for 4 weeks.
on 25/12/95 Reported the onset of menses on 14/12/95 without any complaint of sadnes, pain breasts, or urging for urination. The fear of animals still persisted but it was much lesser. There was o fear of downward motion prescribed placebo for another one month.
On 15/3/96 the pateint visited alone to my clinic to tell me that she was much confident, can go alone anywhere, no fear of animals. Wants to keep a pet dog. No fear of descending the stairs. NO MEDICINE . NO PLACEBO

Rubrics Selected For Repertorisation:

  1. Fear, downward motion, of SRI 495
  2. Fear, dogs, of SRI 495
  3. Ailments, anticipation from SRI 15
  4. Company, desire for and amel. SRI 150
  5. Urging, urination for, ineffectual KR 654
  6. Pain , breasts, menses, before KR 881
  7. Sadness, melancholy, despondent, menses, beforeSRI 884
  8. Undertaken many things , perseveres in nothing, SRI 1052

Only 2 remedies are common to these rubrics First grade: Lac. can cover 8 rubrics with total value 14. 
Second grade. Cal-carb covers 7 rubrics with total no: 13

Author's Comments:
It is very important to go into the detail of the history of the patient , his likings and dislikes, his fears and mentality alongwith the physical symptoms. In the above case if I ahd considered the fear of downward motion as a main symptom ignoring the other more important concomitants I would have prescribed BORAX which might have eliminated patient's fear but the other symptoms could have persisted and the prescription shown a failure.
The other important thing here is the symptom: fear of dogs, which the selected medicine ahs cured, while it has not been mentioned in the repertoire/Materia medica.