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Case Study

Cases From Our Rich Heritage
Dr T K Kasiviswanthan
'Sacch-off / Thuja / Nat-ph

A 29 yrs old woman consulted Dr Tinus Smits in Dec 1989 for PMS from which she was suffering for the past 10 years. On examination one found a lot of small fibromas, an enlarged uterus and swollen ovaries. Before and during menses, she had a sore pain in her lower abdomen, a bearing-down feeling and also a swelling sensation in her whole abdomen with a lot of flatulence, difficult stool and nausea on rising and before meals, weariness and sleepiness and difficult concentration and irritability. Very changeable mood; very thirsty and craved chocolate, oranges lemon, sour fruits. Aversion to meat and bananas. 

She had a lot of problems in her childhood. Being second of four children and the eldest girl, she had to shoulder the heavy responsibility for taking care of her younger siblings. She tried, without success, to get the attention of her mother including blackmailing her during puberty by not eating and refusing to talk for days. She was also critical of her. She was easily disgusted, washed her hands frequently up to 25 times a day. Loved dancing, reading and traveling. Wept with music. She is very fastidious. As there was a history of cancer in the family and there were enormous number of moles which grew during after her pregnancies and the fact that she was aggravated in a warm room and wanted windows to be open, the doctor prescribed Carcinosin 200 on 18/2/94. 

After one week she felt very tired and fell asleep whenever she sat down. But her concentration improved; had no fits of anger, no sadness and PMS was also better. But the patient became worse in March; she was chilly, was eating bread the whole day but losing weight, cramps in abdomen, much flatus, very tired and dry hair and very thirst. These new symptoms clearly indicated Saccharum-off but as the doctor was not conversant with this remedy he prescribed Carcinosin 1M. 

At first she was very restless and had an attack of 'flu' but no PMS. She got pregnant in September, whereafter she had constipation alternating with diarrhoea and cramps in abdomen before stool. She had, however, tremendous appetite. She was given Opium 10M on 30/1/91. The patient felt much better till March 91. It was repeated in the same potency more frequently till her delivery in June. Since her delivery she had persistent problems with her bowels, overwhelming sleepiness after each meal, chronic flu, very chilly and unconscious loss of urine. Opium 10M was given but there was not much amelioration. Nux-vom 10M was prescribed because of nausea before stool, cramps, backache, chilliness, bad concentration and forgetfulness. 

Though some amelioration was there, no improvement was noticed after repetition.
Discouraged by lack of improvement, the patient did not turn up for one year. In the meantime she had salpingitis with high fever which was treated with antibiotics (Agg during ovulation is a strong Saccharum-off symptom). She had again her PMS and still a lot of bowel pain. She was in very bad humour and tired in the morning and had dry skin. Very thirsty and hungry all day and enormous desire for sweets. Preferred raw vegetables and bread to cooked vegetables. She was sensitive to pain. 

She was prescribed Sacch-off 1M every three weeks on 27/10/93. She felt better and in December she was in bad shape, very ill with purulent discharge from her right ear. Earlier in that month she could not walk as if paralysed in her right leg which she had had as a child. Not being so sure of the remedy for the ear infection, the doctor repeated Sacch-off 30 in water for two days without success and then gave Opium 200 and then Hepar-sulph 200 without much relief. 

Her ear continued to discharge on offensive pus for next three months and the patient again came for treatment in May. It was observed that she was very tired, but so restless that she could hardly sit; her PMS was worse and again she had an insatiable appetite. Dr Smits was convinced that the remedy Saccharum was the similimum but the potency given earlier was too high. Hence he prescribed Sacch-off 0/6, one pill a day. 

There was remarkable improvement in the patient's symptoms thereafter. She was less angry, had a lot of energy, and her irresistible craving for food was gone. Her memory was much better and fear of mice gone. Discharge from ear and pain and chilliness were gone. PMS was much better. She was more independent and began to dress well and her relations with her mother, children and husband improved. Though she still had pain in lower abdomen around menses and constipated before menses she was emotionally much better off. (Dr Tinus Smits)

A woman, aged 28, had aborted twice in the earlier months of her pregnancies. After the first abortion, she also suffered from continuous hemorrhage. Her third pregnancy also resulted in abortion and the allopathic treatment did not help at all as the hemorrhage continued, never ceasing. During the intermenstrual period, the flow was pale, watery while during the menses, which was irregular as to time, there was copious discharge of bright red blood which lasted for 10 days, with clots in it. 

In the presence of the doctor, the patient was very pleasant. After his departure she raved at the family; no one could please her as she was very irritable. She did not want to be approached by her family especially her mother. She was sad and dejected and despair of recovery. 

There was frequent urge to urinate, which was worse during menses, with burning sensation. Must await a long time before urine would start. There was pain in the ovary before and after urination, but not while urinating. All her pains were worse from motion. Sleepless and extremely nervous. 

After careful study of the symptoms, Dr Kent selected Thuja and it was given 1M potency in April 1888. At a follows-up after 3 months, the patient reported that there was very little pain during the previous menstrual period. As the mental symptoms returned, Thuja 1M was repeated on 8/8/88. When the case was reviewed on September 12, the patient reported that she was much better, no pain during menses and her mental symptoms were better. There was continued improvement till December when Thuja 2M had to be prescribed as the mental symptoms and pain returned. 

There was continued improvement till May 22, 1889, when again Thuja 2M was given following pain in ovaries though there was no abnormal flow during the intermenstrual period. Thereafter she became well and started enjoying life. There were of course frequent nervous headaches, pain in spine and lumbar regions, rheumatic lameness in lower extremities and constipation since July 1989 but no medicine was given and these symptoms passed off. In February 1890, the ovarian pain returned during menses and Thuja 2M was repeated. Thereafter the reports were that she was completely cured of her ailments and living a healthy life. 

[Dr Kent has not given the rationale for prescribing Thuja but his comments on the remedy in his Lectures on Materia Medica will clarify the position. He writes in his Lectures [page 998] "one particular gland, the ovary is more affected than any other especially the left. This is so true that if you meet a violent pain in the left ovary coming on at the time of menstruation and continuing during the flow .... it is a very strong indicator for Thuja group. Where the ovaries have been affected for some time there will be mental symptoms, a most violent irritability, jealousy, quarrelsomeness and ugliness. This irritability is likely to be shown towards individuals about the house toward the husband and the mother; she is yet able to control herself among strangers and the doctor may not be able to find about it. because she has in her nature a disposition to cheat." Again he writes "The kidney and urinary symptoms are also striking; burning urine, paralysis of the urine to start". One can see how accurately the case symptoms match with the description of the remedy]


Mrs AP, aged 28 yrs, complained of severe, intermittent, cramping abdominal pains which would start one day prior to onset of menses. When the menstrual flow started, the pains also increased. The pains were aggravated by application of heat on the abdomen, back, analgesics pressure, sleep and rest. The concomitants were that the patient was extremely debilitated on the first day of the menses and had to remain in bed for 8 hours. She had also nausea and gastric acidity with menstrual symptoms. The menses began at the age of 12 years and were always irregular. Colocynthis and prescribed did not have any effect. The patient was asked to give a written history on her illness. It revealed that she would take time to get adjusted to new situations, was reserved and terrified when asked to make presentations. When punished as a child she would accept the punishment but would sulk and cry for days. She avoided physical and verbal confrontation. She was afraid of dark, death and heights. Extremely sensitive to cold and she suffered from hay fever every spring. 

The picture of a reserved woman, who was fearful, avoided confrontation, tendency to sulk and brood as a child together with the nature of menstrual pain with characteristic amel from pressure and heat and physical general symptom of chilliness suggested Mag-phos. It was prescribed in 30th potency in weekly doses but there was no change in the next menses; there was no relief even after repeating it more frequently. 

The case was studied again and the following additional symptoms were elicited:-
1. Cracking of cervical vertebra which was agg by physical exertion.
2. Tongue coated white.
3. Craving for sweets
4. Chilly patient with icy cold feet covered while in bed.
5. Head pain prominent agg by soft drinks and sweets
6. Mortified when teased and brooding. 

The revised disease picture clearly showed elements of Natrum personality, such as sulking and brooding and mortification when teased. The cracking of joints and getting hay fever during spring season is clearly Natrum-mur. However not all symptoms were covered by Natrum-mur. Fear of dark and death and chilliness indicated Phosphorus and hence a synthetic prescription of Natrum-phos was made. It was prescribed in 30 potency at weekly intervals. During next menses her symptoms were 80% better and there was no pain on the previous day of the menses. Thereafter Natrum-phos was given twice a week but as there was no further improvement Thuja 200 was prescribed and thereafter she was 95% better. (Dr Soak Pather)

1 Sacrum off- Dr T. Smits- Homeopathic Links-
2 Model cure- Dr Kent, Kent's Minor Writings edited by -Dr K H Gypser, page 300
3 Kent's Lectures on Materia Medica
4 A case of Dysmenorrhoea- Dynamis, issue no 3, Dec 1992